Disclosures: Nicholas C. Elwert, DO: Nothing to disclose

Case Description: Patient is a 42-year-old female with spastic diplegic cerebral palsy status post intrathecal baclofen pump who presented with 2-3 months of radiating low back pain into her right lower extremity in a non-dermatomal distribution with associated numbness, tingling and increased spasticity. Following onset, the patient transitioned from using a single point cane to Lofstrand crutches and her pump was increased by a total of 12% with little effect. Lumbar spine magnetic resonance imaging (MRI) was obtained with findings significant for a broad eccentric disc bulge at L2/L3 with bilateral neuroforaminal stenosis. An electrodiagnostic study was suggestive of a right S1 radiculopathy. She failed to obtain lasting relief with manual manipulation, trigger point injections, oral steroids, physical therapy, addition of intrathecal bupivacaine or L5/S1 epidural steroid injection. Interval MRI was obtained demonstrating progression of the L2-L3 disc herniation with resultant severe spinal canal stenosis. She was referred for neurosurgical evaluation and underwent L2-L3 lumbar microdiscectomy and laminectomy.

Setting: Outpatient Clinic

Patient: 42-year-old female with spastic diplegic cerebral palsy.

Assessment/Results: Following surgery, she completed an acute inpatient rehabilitation admission where she progressed from dependent to modified independent ambulation up to 300 feet with Lofstrand crutches. At 2 months postop, her lower extremity radicular pain resolved and her spasticity returned to baseline.

Discussion: There are many common stimuli that provoke the worsening of spasticity. Given resolution of her symptoms with lumbar decompression, we suspect that the radicular pain associated with her spinal canal stenosis was the stimulus provoking her change in spasticity. This case highlights a less common cause of worsened spasticity.

Conclusion: In patients with cerebral palsy, an underlying radiculopathy has the potential to manifest as increased spasticity. This case demonstrates the need for an extensive history, physical examination and medical work-up for increased spasticity as common pathologies have the potential to present with uncommon presentations.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/increased-spasticity-secondary-to-disc-herniation-in-spastic-diplegic-cerebral-palsy-a-case-report/