Spasticity is a manifestation of a brain or spinal cord injury. As such the management of spasticity is not usually aimed at the cause but is aimed at symptomatic treatment. In the authors unit there is a multidisciplinary team evaluation of all patients with spasticity, whatever the cause, to determine which of the many modalities of treatment may be the best. Neurosurgical treatments are but one small part of the armamentarium and should not be considered in isolation of the holistic treatment of the patient, and their family/carers.Neurosurgical treatments include peripheral neurotomy/neurectomy, intrathecal baclofen pump insertion, selective dorsal rhizotomy and/or deep brain stimulation. The purpose of this article is to remind the reader about these options and enable the reader to direct their patients for the correct assessments/treatments. Patient selection is determined by experience and by use of a previously published algorithm (see Further reading list). There will not be any discussion about selection in this article as this is more than adequately covered in the article referred to above. This article is not meant to be exhaustive and is meant to guide the reader and not inform about every possible nuance, complication, etc. The reader is encouraged to refer their patients to the teams for evaluation rather than referring them for a specific treatment.