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

Abstract

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).

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

“…Failures can also be explained by the underlying pathophysiology of muscle overactivity, encompassing spasticity, spastic dystonia and co-contraction ( 1 ). Neurotomy disrupts the myotatic reflex by severing afferent fibres, leading to a reduction in spasticity as evidenced in this study and others ( 24 ). While sensory reinnervation is theoretically improbable, explaining the long-term effectiveness of neurotomy on spasticity ( 16 ), its impact on spastic dystonia and co-contraction is less certain.…”

“…Another study investigated kinematic changes in walking following ON, but the population and surgical project were different ( 24 ). This study focused exclusively on patients with spinal cord injury exhibiting severe spasticity, of which 8 were ambulatory (walking) patients.…”

“…After resection of this tissue, electrical stimulation was applied to each branch to trigger contraction of the hip adductor muscles. Each branch was then sectioned until there was no response to 1 mA electrostimulation of the proximal part of the fascicle ( 24 ) approximately corresponding to a 90% resection ( 15 ) ( Fig. 1e and f ).…”

“…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 ).…”

“…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 ).…”