Spasticity Surgery

Overview

Spasticity is involuntary muscle tightness, stiffness, or spasms that result from injury or disease affecting the brain or spinal cord. It is common after stroke, traumatic brain injury, spinal cord injury, cerebral palsy, multiple sclerosis, and other neurologic conditions.

Spasticity is not caused by the muscle itself. It reflects an imbalance in the signals that normally help muscles tighten and relax smoothly. A spastic muscle may feel strong because it is tight, but useful strength can actually be limited. After tone is reduced, underlying weakness may become more obvious, which is why treatment has to be planned carefully.

The goal of treatment is to reduce harmful tightness while preserving useful strength and improving comfort and function.

Symptoms

• Stiff, tight muscles that resist movement
• Painful muscle spasms or cramping
• Difficulty with positioning, hygiene, walking, or hand use
• Contractures (fixed tightening) over time
• Limited benefit from oral medications or injections
• Clonus, exaggerated reflexes, or sudden jerking movements
• Trouble fitting braces, shoes, splints, or wheelchair supports
• Skin irritation or pressure sores from positioning problems
• Sleep disruption, fatigue, or caregiver difficulty due to spasms
• Speech, swallowing, bladder, or bowel issues when tone affects broader motor control

Causes and triggers

Spasticity can follow many neurologic conditions, including stroke, cerebral palsy, traumatic brain injury, spinal cord injury, multiple sclerosis, brain or spinal tumors, infection, anoxic brain injury, and other disorders affecting motor pathways.

Symptoms can fluctuate. Before escalating treatment, it is important to look for triggers that may worsen tone, such as pain, infection, pressure injury, constipation, urinary retention, bladder infection, cold temperature, fatigue, emotional stress, poor sleep, or a poorly fitting brace.

Evaluation

Evaluation starts with the patient’s goals. For one person, the priority may be walking more safely. For another, it may be easier hygiene, fewer painful spasms, better sleep, improved sitting position, or making care less difficult.

Assessment may include:

• Mapping which muscles are overactive and which are weak
• Distinguishing spasticity from dystonia, contracture, rigidity, tremor, or pain guarding
• Reviewing therapy, bracing, injections, oral medication, and prior procedures
• Looking for fixed contractures or joint deformity that may not improve with tone reduction alone
• Clarifying whether tone is harmful or whether some tone is helping standing, transfers, or posture

Dr. Barone’s Approach

Dr. Barone evaluates spasticity within a multidisciplinary team, considering each patient’s goals — whether reducing pain, easing care, or improving function. As a functional neurosurgeon, he tailors treatment to the pattern and severity of spasticity, drawing on both established surgical techniques and a research background in neural interfaces and neurorestoration.

Treatments Offered

• Intrathecal baclofen therapy (medication pump) for generalized spasticity
• Selective neurosurgical procedures for focal spasticity
• Neuromodulation approaches in appropriate patients
• Coordinated care with rehabilitation and therapy teams
• Comparison of adjustable treatments, such as pump therapy, with more permanent procedures, such as selective rhizotomy or neurotomy

What to Expect

Your evaluation clarifies the goals of treatment and which option best fits your needs. Dr. Barone will explain how each therapy works, what improvement to expect, and the follow-up involved, including device adjustment for pump therapy. Well-chosen treatment can meaningfully reduce spasticity, ease daily care, improve comfort, and support independence, but it should be paired with rehabilitation and realistic expectations.