DOI QR코드

DOI QR Code

Long-Term Results of Microsurgical Selective Tibial Neurotomy for Spastic Foot : Comparison of Adult and Child

  • Kim, Jong-Hoon (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Lee, Jae-Il (Department of Neurosurgery, Joong Ang Hospital) ;
  • Kim, Min-Su (Department of Neurosurgery, College of Medicine, Yeungnam University) ;
  • Kim, Seong-Ho (Department of Neurosurgery, College of Medicine, Yeungnam University)
  • Received : 2009.10.15
  • Accepted : 2010.03.31
  • Published : 2010.04.28

Abstract

Objective : Selective neurotomy is generally a safe, effective, and long-lasting treatment for patients with spastic equinovarus foot deformity. We retrospectively analyzed the results of microsurgical selective tibial neurotomy (STN) for spastic feet in adults and children. Methods : A neurosurgeon selected 32 patients with 45 spastic feet (adults : 13, children : 32) to undergo microsurgical STN between October 1998 and September 2007. A physician of rehabilitation assessed spasticity pre- and postoperatively, that was based on the Ashworth scale, ankle clonus, and the amplitude of ankle dorsiflexion. The mean postoperative follow-up period was 36.7 months in adults and 42.5 months in children. Results : Spastic components of the feet were corrected immediately after surgery in both the adult and child groups. The mean Ashworth's grade changed from $3.6{\pm}0.40$ to $1.6{\pm}0.70$ in adults and from $3.7{\pm}0.69$ to $1.4{\pm}0.49$ in children. Mean ankle clonus decreased markedly, from $1.6{\pm}0.79$ to $0.3{\pm}0.42$ in adults and from $1.7{\pm}0.65$ to $0.3{\pm}0.56$ in children. The mean amplitude of ankle dorsiflexion was improved, but eight (adults: 4, children: 4) contracted feet needed complementary orthopedic correction for acceptable results. Conclusion : STN can be effective in the long-term for improving lower limb function and reduction of equinovarus deformity. Our results demonstrate that STN might be an effective procedure for treating localized harmful spastic feet in adults and children.

Keywords

References

  1. Baroncini M, Baiz H, Wavreille G, Demondion X, Maurage CA, Buisset N, et al. : Anatomical bases of tibial neurotomy for treatment of spastic foot. Surg Radiol Anat 30 : 503-508, 2008 https://doi.org/10.1007/s00276-008-0359-9
  2. Brunelli G, Brunelli F : [Selective microsurgical denervation in spastic paralysis.] Ann Chir Main 2 : 277-280, 1983 https://doi.org/10.1016/S0753-9053(83)80016-7
  3. Buffenoir K, Roujeau T, Lapierre F, Menei P, Menegalli-Boggelli D, Mertens P, et al. : Spastic equinus foot : multicenter study of the longterm results of tibial neurotomy. Neurosurgery 55 : 1130-1137, 2004 https://doi.org/10.1227/01.NEU.0000140840.59586.CF
  4. Caillet F, Mertens P, Rabaséda S, Boisson D : [Three dimensional gait analysis and controlling spastic foot on stroke patients.] Ann Readapt Med Phys 46 : 119-131, 2003 https://doi.org/10.1016/S0168-6054(03)00015-1
  5. Collado H, Bensoussan L, Viton JM, Milhe De Bovis V, Delarque A : Does fascicular neurotomy have long-lasting effects? J Rehabil Med 38 : 212-217, 2006 https://doi.org/10.1080/16501970500538024
  6. Decq P : [Peripheral neurotomies for the treatment of focal spasticity of the limbs.] Neurochirurgie 49 : 293-305, 2003
  7. Deltombe T, Detrembleur C, Hanson P, Gustin T : Selective tibial neurotomy in the treatment of spastic equinovarus foot : a 2-year follow-up of three cases. Am J Phys Med Rehabil 85 : 82-88, 2006 https://doi.org/10.1097/01.phm.0000193506.70371.cf
  8. Hoffman H : Local re-innervation in partially denervated muscle; a histophysiological study. Aust J Exp Biol Med Sci 28 : 383-397, 1950 https://doi.org/10.1038/icb.1950.39
  9. Hong JC, Kim MS, Chang CH, Kim SW, Kim OL, Kim SH : Long term results of microsurgical dorsal root entry zonotomy for upper extremity spasticity. J Korean Neurosurg Soc 43 : 182-185, 2008 https://doi.org/10.3340/jkns.2008.43.4.182
  10. Jang SH, Park SM, Kim SH, Ahn SH, Cho YW, Ahn MO : The effect of selective tibial neurotomy and rehabilitation in a quadriplegic patient with ankle spasticity following traumatic brain injury. Yonsei Med J 45 : 743-747, 2004 https://doi.org/10.3349/ymj.2004.45.4.743
  11. Keats S : Combined adductor-gracilis tenotomy and selective obturator-nerve resection for the correction of adduction deformity of the hip in children with cerebral palsy. J Bone Joint Surg Am 39-A : 1087-1090, 1957
  12. Msaddi AK, Mazroue AR, Shahwan S, al Amri N, Dubayan N, Livingston D, et al. : Microsurgical selective peripheral neurotomy in the treatment of spasticity in cerebral-palsy children. Stereotact Funct Neurosurg 69 : 251-258, 1997 https://doi.org/10.1159/000099884
  13. Rafuse VF, Gordon T, Orozco R : Proportional enlargement of motor units after partial denervation of cat triceps surae muscles. J Neurophysiol 68 : 1261-1276, 1992 https://doi.org/10.1152/jn.1992.68.4.1261
  14. Sindou M, Mertens P : Selective neurotomy of the tibial nerve for treatment of the spastic foot. Neurosurgery 23 : 738-744, 1988 https://doi.org/10.1227/00006123-198812000-00009
  15. Sindou MP, Simon F, Mertens P, Decq P : Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst 23 : 957-970, 2007 https://doi.org/10.1007/s00381-007-0399-1

Cited by

  1. Improvement of Sitting Ability and Ambulation Status after Selective Peripheral Neurotomy of the Sciatic Hamstring Nerve together with Obturator Branches for Severe Spasticity of the Lower Extremities vol.90, pp.5, 2010, https://doi.org/10.1159/000338679
  2. Highly Selective Partial Neurectomy for Lower-Extremity Spasticity : 2-Dimensional Operative Video vol.20, pp.6, 2021, https://doi.org/10.1093/ons/opab020