Evaluation of selective peripheral neurotomies in the treatment of refractory lower limb spasticity in adults

Abstract

Background: ''Selective peripheral neurotomies" (SPNs) are indicated for the treatment of refractory focal and multifocal spasticity of lower limbs in adults. Objective: To evaluate the surgical results of selective peripheral neurotomies in 20 adult patients who had refractory focal & multifocal spasticity of the lower limbs, follow up period of one year. Patients and Methods: Prospective study included 20 adult patients who had refractory spasticity of the lower limbs. Preoperative evaluation for muscle tone using Modified Ashworth Score (MAS), muscle power using Medical Research Council Scale (MRCS), functional assessment using Oswestry Functional Scale (OFS) and Range Of Motion (ROM) using manual goniometry were done for all patients. All cases underwent surgery in the form of SPN of tibial, obturator, sciatic and/or femoral nerves. Follow up of the patients was done at 10th day, 3, 6 months and one year postoperatively. Results: The mean age of patients was 31.35 ± 12.42 years. There were statistically significant improvement of muscle tone, muscle power, functional assessment and range of motion between preoperative and one year postoperative values. Improvement of the muscle tone was from a preoperative Mean ± SD of 3.60 ± 0.68 on MAS to a postoperative 2.30 ± 0.86 at one year, improvement of muscle power on MRCS was from preoperative Mean ± SD 3.75 ± 1.08 to postoperative 4.08 ± 0.69 at one year, There was a functional improvement from a preoperative Mean ± SD of 3.0 ± 0.73 on OFS to 3.60 ± 0.60 at one year postoperatively. Also, there was a significant improvement between preoperative ROM Mean ± SD 61.25 ± 15.29 and one year postoperatively 72.25 ± 12.19. Conclusions: Selective peripheral neurotomies could effectively improve muscle tone, muscle power, functional performance & range of motion in patients with refractory focal and multifocal spasticity in the lower limbs.

Selective peripheral neurotomy (SPN) as a treatment strategy for spasticity

“…At the same time, this procedure may induce paralysis to the targeted muscles. SPN aims at restoring the balance between agonist and antagonist muscles to maintain normal movement and posture [13, 14]. Decreasing the uninhibited stretch reflex, at the level of a muscle’s nerve, is SPN’s mechanism of action.…”

May Spasticity-Related Unpleasant Sensations Interfere with Daily Activities in People with Stroke and Traumatic Brain Injury? Secondary Analysis from the CORTOX Study

“…Among the therapeutic approaches, pharmacological treatments, such as oral medications (e.g., tizanidine and dantrolene), intrathecal baclofen, as well as phenol or botulinum toxin injections, and non-pharmacological, such as electro-neuromuscular stimulation, orthotics, acupuncture, and physical activity programs have shown potential benefits [ 6 , 8 ]. Furthermore, surgical techniques such as nerve blockades, tendon lengthening, and selective neurectomy play a crucial role in reducing spasticity, correcting deformities, and improving limb functionality, especially when integrated within a multidisciplinary framework emphasizing comprehensive evaluation and dedicated post-surgery rehabilitation for the best outcomes [ 9 , 10 , 11 ].…”