Long-term effect of tibial nerve neurotomy in stroke patients with lower limb spasticity

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.

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“…In agreement with our study, Rousseaux et al 17 reported a lasting drop in spasticity (2.5 points on the MAS).…”

Section: Discussionsupporting

confidence: 94%

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

Salem

El-Saadany

Fouad

et al. 2018

Alexandria Journal of Medicine

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“…There were no significant differences in the basic parameters of gait (step length, stride speed, step width, stride range) and the angle of hip flexion and knee flexion in the swing phase compared with preoperative surgery. This finding may be related to the fact that the patient did not undergo sufficient time-standardized rehabilitation training and the follow-up evaluation time after the surgery was short [ 13 , 21 ]. FAC results show that the patient’s gait after surgery was better than that before surgery, and some patients could walk independently after surgery.…”

Section: Discussionmentioning

confidence: 99%

Combined selective peripheral neurotomy in the treatment of spastic lower limbs of spinal cord injury patients

Liu

Fan

et al. 2022

Acta Neurochir

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Objective To explore the therapeutic effect of combined selective peripheral neurotomy (cSPN) on the spasm of the lower limbs after spinal cord injury. Methods A prospective intervention (before-after trial) with an observational design was conducted in 14 spinal cord injury patients with severe lower limbs spasticity by cSPN. Given the severe spasm of hip adductor, triceps surae, and hamstring muscles in these patients, a total of 26 obturator nerve branches, 26 tibia nerve branches, and 4 sciatic nerve branches partial neurotomy were performed. The modified Ashworth scale, composite spasticity scale, surface electromyography, gait analysis, functional ambulation category, spinal cord independence measure, and modified spinal cord injury–spasticity evaluation tool were used before and after surgery. Results Compared with preoperative, the spasm of the hip adductor, triceps surae, and hamstrings of the lower limbs in the postoperative patients decreased significantly. The abnormal gait of knee flexion and varus in the standing stage were significantly reduced. The grading of walking ability and activities of daily living were significantly improved. Conclusions Combined selective peripheral neurotomy can significantly reduce the spasm of lower limbs post spinal cord injury, improve abnormal gait, and improve motor function and activities of daily living. Trial registration ChiCTR1800019003 (2018–10-20).

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“…Some ambulatory patients harboring concomitant bilateral spastic hip adductors with preoperative scissoring gait acquired a satisfactory result following SPN of the anterior obturator nerve. Appreciable improvement of gait function was the magnificent highlight of numerous studies focusing on tibial nerve neurotomy [27,28,29,30,31,32,33,34]. A recent comparative study revealed the superiority of tibial neurotomy to botulinum toxin injection in terms of spasticity reduction, increased voluntary range of motion, correction of equinus and varus ankle deformation, enhanced balance and gait velocity, subjective improvement in daily living situations and diminished demand for walking orthosis [35].…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

Sitthinamsuwan¹,

Chanvanitkulchai²,

Phonwijit³

et al. 2013

Stereotact Funct Neurosurg

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Background: The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of severe intractable focal and multifocal spastic hypertonia. We occasionally operated SPN in diffuse spastic disorders. Objective: To study surgical outcome of SPN in terms of severity of spasticity and functional condition. Methods: Patients harboring refractory harmful spasticity of various origins were enrolled into the present study. They were clinically evaluated by using the Modified Ashworth Scale (MAS), passive range of motion (PROM) and functional status. These variables were compared between pre- and postsurgery by using the paired t test and the Wilcoxon signed-rank matched-pairs test. Results: One hundred and forty-one SPNs were accomplished in 33 patients. Overall mean pre- and postoperative MAS and PROM were 3.0 and 0.7 (p < 0.001) and 78.3 and 102.3° (p < 0.001), respectively. Analysis of individual SPN subgroups also demonstrated statistically significant improvement of both parameters. Furthermore, we found significant gait improvement among 10 ambulatory subjects. Nine bed-bound cases attained significant enhancement of sitting competency and ambulatory condition. Conclusion: SPN is an efficacious neurosurgical intervention in the treatment of spasticity. It is apparently beneficial in the reduction of spasticity, amelioration of functional status, facilitation of patient care and prevention of long-term musculoskeletal sequelae.

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Long-term effect of tibial nerve neurotomy in stroke patients with lower limb spasticity

Cited by 35 publications

References 22 publications

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

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

Combined selective peripheral neurotomy in the treatment of spastic lower limbs of spinal cord injury patients

Surgical Outcomes of Microsurgical Selective Peripheral Neurotomy for Intractable Limb Spasticity

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