Hyper-selective neurectomy for knee flexion spasticity: anatomic bases and surgical technique

Emamhadi, Mohammadreza; Alijani, Babak; Dogahe, Mohammad Haghani; Emamhadi, Amirreza

doi:10.1007/s00276-022-03074-8

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…The use of elective peripheral neurectomy to mitigate muscle spasticity has received growing attention in recent years. While most evidence supported its use in lower limbs [17][18][19][20][21] and a recently developed recommendation included selective neurectomies among treatments for post-stroke equinovarus foot deformities [22], no recommendations exist for upper limbs. However the effectiveness of selective peripheral neurectomies to treat ULS has been reported [13,14,18,[23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…The first one was described by Stoffel and colleagues [15] and then by Brunelli and Brunelli [16], becoming increasingly common procedures. While their origins date back to the first decades of the 20th century, selective peripheral neurectomy has received growing attention in recent years since this procedure has been demonstrated to mitigate muscle spasticity, particularly in lower limbs [17][18][19][20][21]. Based on this evidence, in fact, an international, interdisciplinary Delphi panel recently included selective neurectomies among the treatments for poststroke equinovarus foot deformities [22].…”

Section: Introductionmentioning

confidence: 99%

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Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure

Zerbinati,

Bemporad,

Massimiani

et al. 2024

JPM

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Internally rotated and adducted shoulder is a common posture in upper limb spasticity. Selective peripheral neurectomy is a useful and viable surgical technique to ameliorate spasticity, and the lateral pectoral nerve (LPN) could be a potential good target to manage shoulder spasticity presenting with internal rotation. However, there are some limitations related to this procedure, such as potential anatomical variability and the necessity of intraoperative surgical exploration to identify the target nerve requiring wide surgical incisions. This could result in higher post-surgical discomfort for the patient. Therefore, the aim of our study was to describe a modification of the traditional selective peripheral neurectomy procedure of the LPN through the perioperative ultrasound-guided marking of the target nerve with methylene blue. The details of the localization and marking procedure are described, as well as the surgical technique of peripheral selective neurectomy and the potential advantages in terms of nerve localization, surgical precision and patients’ post-surgical discomfort. We suggest that the proposed modified procedure could be a valid technique to address some current limitations and move the surgical treatment of spasticity toward increasingly tailored management due to the ease of nerve identification, the possibility of handling potential anatomical variability and the resulting smaller surgical incisions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure

Zerbinati,

Bemporad,

Massimiani

et al. 2024

JPM

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“…eine Serie von 18 Patienten mit erfolgreicher Reduktion bei FDS-Spastik nach vorherigem Release des M. pronator teres (siehe Tab. 3 ) 16 .…”

Section: Operationstechniken An Der Oberen Extremitätunclassified

Die hyperselektive Neurektomie bei spastischen Lähmungen der oberen Extremität

Megerle,

Gohritz

2024

Handchir Mikrochir Plast Chir

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ZusammenfassungAls hyperselektive Neurektomie wird eine gezielte Durchtrennung motorischer Nervenfasern an ihrem Muskeleintritt bezeichnet, um bei spastischen Lähmungen den gesteigerten Muskeltonus zu reduzieren. Diese Technik hat in den letzten Jahren speziell an der oberen Extremität eine Renaissance erlebt. Wichtigste Grundlage ist die exakte Kenntnis der topographschen Anatomie der Muskelinnervation. Um Ausmaß und Lokalisation der Denervation exakt kontrollieren zu können, ist eine präzise Darstellung der motorischen Nervenäste notwendig. Für eine relevante Tonusminderung ist die Durchtrennung von 2/3 bis 4/5 der Nervenäste erforderlich. Diese Arbeit stellt die Entwicklung, Prinzipien und Anwendung dieser Techniken an der oberen Extremität dar und gibt einen Überblick über die klinischen Ergebnisse.

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Innervation patterns of hamstring muscles, including morphological descriptions and clinical implication

Farfán,

Rojas,

Olivé-Vilás

et al. 2024

Surg Radiol Anat

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Hyper-selective neurectomy for knee flexion spasticity: anatomic bases and surgical technique

Cited by 5 publications

References 18 publications

Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure

Lateral Pectoral Nerve Identification through Ultrasound-Guided Methylene Blue Injection during Selective Peripheral Neurectomy for Shoulder Spasticity: Proposal for a New Procedure

Die hyperselektive Neurektomie bei spastischen Lähmungen der oberen Extremität

Innervation patterns of hamstring muscles, including morphological descriptions and clinical implication

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