Areas of Expertise

Neurorestoration & Reconstruction for Paralysis, Spasticity & Pain

There are multiple options to treat also long standing functional deficit and pain after cerebral- and spinal cord lesions and nerve injury. Many of those procedures are in use since long. In recent years more and more so called nerve transfers have been used to regain lost function following stroke and spinal cord injury (SCI).

In selected patients it is possible to improve function and pain situation considerably.

Key is a comprehensive, and thorough, often interdisciplinary, examination of the patient and

evaluation of his functional loss. Having access and knowing about the whole armamentarium of possible procedures is crucial (e.g. neurosurgical- and reconstructive procedures, classic hand surgery, traumatological & orthopedic expertise, pain modulating procedures, physio- and occupational therapy, rehab etc.).

It is very helpful to have all the specialists at hand at a centre of expertise in order to counsel for sub-areas. At the Klinikum Klagenfurt we created a growing interdisciplinary hub with specialists interested in improving function in the sense of a "Paralysis Centre". We can offer to share our knowledge, consult and perform the relevant procedures.

Nerve injuries

Irrespective if injured during daily living or during surgery (iatrogenic injury) traumatic nerve lesions are not rare. They have grave impact on quality of life and work capability. Despite the functional loss they are frequently painful (neuropathic pain). With regard to adequate treatment modalities also of substantial nerve injuries there often is insecurity amongst physicians. If there is no spontaneous functional improvement under conservative therapy all to often microsurgical nerve treatment modalities are completely underrated. We offer the whole spectrum of modern nerve repair and reconstructive surgery in order to regain function, and on a scientific basis helped to develop it further : microsurgical neurolysis, intraoperative monitoring, high frequency nerve ultrasound (pre- and intraoperative), nerve grafting, nerve transfers, and substitute operations (tendon transfers, FFMT). It is essential to discern types of injury, and to realize potential for spontaneous recovery or not in dependance of nerve affected. Critical for me to judge, if surgery can help is thorough history and examination. Modern imaging from High Frequency Nerve Ultrasound and Magnetic Resonance Imaging (MRI) together with devoted electrophysiology are important additional measures.

Paralysis after stroke & spasticity

Worldwide 300-500 human beings per 100.000 people in the age-group from 45-84 Jahren are hit by a stroke annually. The consequences are very distinct. After hemiparesis or paralysis of an extremity frequently a movement reducing and painful spasticity develops. Frequently it is possible to improve such a condition considerably by use of a single or several combined surgical measures.

Spinal cord injury (SCI) & Paraplegia

Patients who are paraplegic after SCI in selected cases can benefit from a so called "nerve bypass": still functioning nerves above the lesion are used to innervate muscles which lost function at and below lesion levels. With this method (a nerve transfer), selected, partial muscle functions that are of help in daily living can sometimes be regained. Usually a comprehensive treatment concept by different involved disciplines in several steps is necessary.

Spasticity

A classical method to soften the hardened muscle is by application of Baclofen, a muscle relaxant. If the testing phase shows a positive result, a Baclofen-pump can be implanted that applies a defined dose of Baclofen at a constant rate close to the spinal cord (often used in paraplegics after spinal cord). Another method which for some patients is more suitable is a selective-peripheral-denervation of a spastic muscle or muscle-group. Herewith the direct connection from innervating nerve to muscle is microsurgically cut. By transecting only some of the fascicles the effect can even be modulated (some nerve signals still come through). This procedure can be suitable for patients where the once positive effect of Baclofen weaned off, or never worked (primary or secondary non-responders).

Root avulsion pain - Deafferentiating pain - DREZ Lesioning

Root avulsion at the cervical spinal cord with the consequent brachial plexus lesion can elicit and maintain excruciating and characteristic painful  conditions. If these are not controllable anylonger with medication a procedure called Dorsal Root Entry Zone Lesioning can help to reduce the pain (DREZ lesioning). In principle the area where the root has been torn out of the myelon is microsurgically coagulated to deactivate the firing source of the pain impulse. This procedure, as well, is part of the treatment offer at Klagenfurt for suitable patients.

Keywords
  • Plexus surgery, Plexus injury, Plexus brachialis, Plexus lumbosacralis
  • contralateral C7 Transfer
  • Exoskeletton, removable Orthesis for Arm- and Finger flexion
  • Nerve transfers
  • Muscle- and tendon transfers
  • Nerve grafting, nerve reconstruction
  • Surgical pain treatment for root avulsion, root avulsion pain, Deafferentation pain (Deafferentierungsschmerz)
  • Spasticitly - selective peripheral denervation
  • Baclofen pump for spasticity
  • Muscle transplant
  • "Nerve bypass" for spinal cord injury (SCI)
  • reconstructive Neurosurgery
  • Neurorestoration