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

Abstract

Background: The authors used selective peripheral neurotomy (SPN) on the sciatic and obturator nerves to restore the sitting posture and ambulation in bedridden patients suffering from severe proximal lower limb spasticity. Objective: To study the surgical outcome of sciatic and obturator neurotomies. Methods: All patients with refractory hamstring spasticity who encountered SPN on the hamstring nerve were recruited. Obturator neurotomy was undertaken in some individuals. The clinical assessment included Modified Ashworth Scale (MAS), passive range of motion (PROM), sitting competency and ambulatory condition. These parameters were compared between before and after the surgery by using the Wilcoxon signed-rank test. Results: Among the sciatic neurotomy group (n = 15), the mean pre- and postoperative MAS and PROM were 3.3 and 0.8 (p < 0.01) and 78.3 and 121.7° (p < 0.01), respectively. Those measurements of the obturator nerve surgery group (n = 11) were 3.7 and 1.1 (p < 0.01) as well as 21.0 and 45.0° (p < 0.01), respectively. Seven and 8 of a total of 9 patients had statistically significant improvement in sitting ability (p = 0.016) and ambulation status (p < 0.01), respectively. Conclusion: Bedridden patients who suffer from severe proximal lower limb spasticity have an optimum to return to sitting and ambulate with a wheelchair after SPN of the sciatic and obturator nerves.

Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

“…In the denervating step, we always preserved a number of motor fascicles to avoid atrophic changes of denervated spastic musculature. Some authors encouraged utilization of intraoperative EMG in selective neurotomy [37,38]. In the authors' viewpoint, application of intraoperative EMG for determining the degree of fascicular resection can improve objectivity and is safer than neurotomy based on comparison between pre- and postneurotomy muscular contraction alone.…”

Functional outcomes following surgery for spastic hip adductor muscles in ambulatory and non-ambulatory adults

“…Prior studies on ON have focused on its effect on impairments such as amplitude and spasticity. However, assessments of activity limitations were frequently lacking ( 22 ) or only briefly explored ( 18 , 20 , 23 ). One of the original features of this study is the emphasis on the reduction of activity limitations as the primary outcome, with the selection of individualized functional goals for each patient.…”

“…This study evaluated the modification of passive hip range of abduction in 6 non-ambulatory subjects with cerebral palsy, including 2 adults ( 22 ). More recently, 2 studies evaluated the functional benefits of ON combined with other neurotomies, demonstrating improvements in the ability to sit ( 23 ) and walk ( 24 ). The first study included 9 non-ambulatory patients: all underwent sciatic nerve neurotomy and 7 had associated ON ( 23 ).…”

“…More recently, 2 studies evaluated the functional benefits of ON combined with other neurotomies, demonstrating improvements in the ability to sit ( 23 ) and walk ( 24 ). The first study included 9 non-ambulatory patients: all underwent sciatic nerve neurotomy and 7 had associated ON ( 23 ). In the second study of 14 spinal cord injured patients, all underwent tibial nerve neurotomy, with 13 having ON and 2 having hamstring neurotomy ( 24 ).…”

Terminal nerve entry points’ locations to muscles of the thigh for selective peripheral neurectomy in the adult population: a cadaveric study

“…[6, 15,20] The technique involves identifying the motor rami branching from principal nerve trunks with electrical stimulation, and resection at that level. [21] Contrary, this paper recommends incision sites based on the distribution of locations of terminal motor entry points.…”