Evaluation of Selective Tibial Neurotomy for the Spastic Foot Treatment Using a Personal Goal-Centered Approach: A 1-Year Cohort Study

Dauleac, Corentin; Luauté, Jacques; Rode, G.; Afif, Afif; Sindou, Marc; Mertens, Patrick

doi:10.1227/neu.0000000000002287

Cited by 7 publications

(8 citation statements)

References 33 publications

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“…7 A recent large-scale study of 104 patients used a Goal Attainment Scale and reported that >90% achieved their primary personal goals (ie, comfort when walking) at 1 year after surgery with a third far exceeding expectations. 9 Six of these patients had complications with plantar foot numbness that resolved, which could again be attributed to the authors performing a partial neurotomy at the proximal trunk containing mixed motor/ sensory fibers. Two patients required washout for infection.…”

Section: Resultsmentioning

confidence: 96%

“…Cases of sensory loss or pain were exclusive to cases primarily involving the toe flexors and some TP, where this was accomplished by neurotomy of the tibial trunk. Despite a single case series of 4 patients suggesting a lack of persistence in effect at 6 months, 18 subsequent reports have shown strong support to the contrary, 7-10 suggesting that a more extensive neurotomy might have been required in the former. A prospective series of 51 patients demonstrated a lasting improvement in spasticity, motor control of dorsiflexion, ankle positioning, and gait and balance at 2 years.…”

Section: Resultsmentioning

confidence: 99%

“…5 Alternatively, selective tibial neurotomy (STN) provides a safe, effective, and permanent intervention for the management of SEF. [6][7][8][9][10] Numerous reports have shown STN to be an effective and enduring intervention for focal spasticity. The peripheral neurotomy for spasticity was first described in 1887 by Lorenz, and SEF specifically for the TN was first described by Stoffell in 1912.…”

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confidence: 99%

“…5 Alternatively, selective tibial neurotomy (STN) provides a safe, effective, and permanent intervention for the management of SEF. 6-10…”

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confidence: 99%

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Selective Tibial Neurotomy for Spastic Equinovarus Foot: Operative Technique

Thum,

Bazarek,

Sten

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Spastic equinovarus foot (SEF) is a common complication of stroke and other upper motor neuron injuries. It is characterized by a plantigrade and inverted foot, often with toe curling, causing significant disability from pain, gait, and balance difficulties. Management includes physical therapy, antispasticity drugs, orthoses, chemical neurolysis, or botulinum toxin, all of which may be insufficient, sedating, or transient. Selective tibial neurotomy (STN) provides a surgical option that is effective and long-lasting. Our goal is to provide a concise description of our technique for performing the STN for treatment of SEF. We discuss the standard posterior approach with surgical variations used by other groups and a medial approach, should the posterior approach be insufficient. METHODS: A posterior leg approach allows access to the tibial nerve and its branches to the bilateral gastrocnemius muscles, soleus, posterior tibialis, and extrinsic toe flexors. A medial approach is used if the toe flexors cannot be accessed sufficiently from the posterior approach. Nerve branch targets identified by preoperative functional assessment are carefully exposed and fully neurolysed distally to identify all terminal branches to each muscle of interest before neurotomy. RESULTS: The STN is a powerful tool for treating SEF, with an immediate and lasting effect. Approximately 80% of the target muscle should be denervated to ensure long-term efficacy while maintaining adequate function of the muscle through collateral innervation. CONCLUSION: The STN is a safe and effective outpatient procedure that can be performed by an experienced nerve surgeon to improve balance and ambulation and reduce pain for patients with SEF. Large clinical trials are necessary to further establish this underutilized procedure in the United States.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

“…5 Alternatively, selective tibial neurotomy (STN) provides a safe, effective, and permanent intervention for the management of SEF. 6-10…”

mentioning

confidence: 99%

See 2 more Smart Citations

Selective Tibial Neurotomy for Spastic Equinovarus Foot: Operative Technique

Thum,

Bazarek,

Sten

et al. 2023

Operative Neurosurgery

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“…In addition, this study supports our findings of high satisfaction with these personalized goals after STN. 37 This finding demonstrates the importance of emphasizing validated gait and balance assessments, which are currently underrepresented in the literature. 13…”

Section: Discussionmentioning

confidence: 95%

Selective Tibial Neurotomy Outcomes for Spastic Equinovarus Foot: Patient Expectations and Functional Assessment

LaMarca,

Krenn,

Kelso-Trass

et al. 2023

Neurosurgery

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BACKGROUND: Spastic equinovarus foot (SEF) is a common dysfunctional foot posture after stroke that impairs balance and mobility. Selective tibial neurotomy (STN) is a simple but underutilized surgical option that can effectively address critical aspects of SEF and thereby provide enduring quality of life gains. There are few studies that examine both functional outcomes and patient satisfaction with this treatment option. OBJECTIVE: To elucidate the patient goals that motivated their decision to undergo the procedure and compare subjective and objective changes in balance and functional mobility as a consequence of surgery. METHODS: Thirteen patients with problematic SEF who had previously failed conservative measures were treated with STN. Preoperative and postoperative (on average 6 months) assessments evaluated gait quality and functional mobility. In addition, a custom survey was conducted to investigate patient perspectives on STN intervention. RESULTS: The survey showed that participants who opted for STN were dissatisfied with their previous spasticity management. The most common preoperative expectation for STN treatment was to improve walking, followed by improving balance, brace comfort, pain, and tone. Postoperatively, participants rated the improvement in their expectations and were, on average, 71 on a 100-point scale, indicating high satisfaction. The gait quality, assessed with the Gait Intervention and Assessment Tool, improved significantly between preoperative and postoperative assessment (M = −4.1, P = .01) with a higher average difference in stance of −3.3 than in swing −0.5. Improvement in both gait endurance (M = 36 m, P = .01) and self-selected gait speed (M = .12 m/s, P = .03) was statistically significant. Finally, static balance (M = 5.0, P = .03) and dynamic balance (M = 3.5, P = .02) were also significantly improved. CONCLUSION: STN improved gait quality and functional mobility and was associated with high satisfaction in patients with SEF.

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