Long-Term Results of Microsurgical Selective Tibial Neurotomy for Spastic Foot : Comparison of Adult and Child

Abstract

Objective : Selective neurotomy is generally a safe, effective, and long-lasting treatment for patients with spastic equinovarus foot deformity. We retrospectively analyzed the results of microsurgical selective tibial neurotomy (STN) for spastic feet in adults and children. Methods : A neurosurgeon selected 32 patients with 45 spastic feet (adults : 13, children : 32) to undergo microsurgical STN between October 1998 and September 2007. A physician of rehabilitation assessed spasticity pre-and postoperatively, that was based on the Ashworth scale, ankle clonus, and the amplitude of ankle dorsiflexion. The mean postoperative follow-up period was 36.7 months in adults and 42.5 months in children.Results : Spastic components of the feet were corrected immediately after surgery in both the adult and child groups. The mean Ashworth's grade changed from 3.6 ± 0.40 to 1.6 ± 0.70 in adults and from 3.7 ± 0.69 to 1.4 ± 0.49 in children. Mean ankle clonus decreased markedly, from 1.6 ± 0.79 to 0.3 ± 0.42 in adults and from 1.7 ± 0.65 to 0.3 ± 0.56 in children. The mean amplitude of ankle dorsiflexion was improved, but eight (adults: 4, children: 4) contracted feet needed complementary orthopedic correction for acceptable results. Conclusion : STN can be effective in the long-term for improving lower limb function and reduction of equinovarus deformity. Our results demonstrate that STN might be an effective procedure for treating localized harmful spastic feet in adults and children.

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

“…According to the studies about operative results of SPN, most focused on selective tibial neurotomy in the treatment of spastic equinus or equinovarus foot [24,25,26,27,28,29,30,31,32,33] while there have been a small number of reports with regard to surgical outcomes of hamstring and obturator neurotomy, including our study. Decq et al [34] used SPN in 11 patients who had excessive hamstring spasticity with a high Held’s score for restoration of bipodal stance and walking.…”

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

“…Although several studies have demonstrated the benefits of the STN for stroke patients, 7,8,14-16,30 some authors have also confirmed its effectiveness for other various etiologies of spastic foot (brain injury, spinal cord injury, multiple sclerosis, etc) 4,5,31-33 demonstrating that irrespective of the etiology of the spasticity, a large number of patients with equinovarus foot can improve their disability after both STN and rehabilitation program.…”

Evaluation of the long-term effect of selective tibial neurotomy for the treatment of spastic foot using a personal goal-centered approach

“…33 This situation could explain the deformity recurrence described by some authors. 29,32,[34][35][36] Also, the responsibility of a dystonic component (residual to neurotomy) may play a role in the recurrence of abnormal postures. In this way, Deltombe et al noted a gradual return of passive ankle dorsiflexion as long as 2 years after STN due to retraction of the Achilles tendon after a lack of stretching.…”