Selective neurotomies for relief of spasticity focalized to the foot and to the knee flexors. Results in a series of 58 patients

Fifty-eight patients with a mean age of 24 years (range 5 to 65 years) who underwent selective neurotomies (SN) for harmful spasticity focalized to the lower limb are presented. In 43 of the patients who suffered spastic foot, SN was directed to the tibial nerve. In 10 others who had spastic knee flexors, the target was the hamstring branches of the sciatic trunk. In the remaining 5 patients, SN concerned both nerves. The aim of the section was to reduce partially the number of the fascicles conveying the excessive spasticity. A stimulation of the nerve above and below the section is performed to check the effectiveness of surgery on the corresponding muscle(s). At long-term follow-up evaluation (mean duration: 4.2 years), this study shows that 40 patients (i.e., 68.9% of the cases) experienced a better quality of life, related to the disappearance or a notable regression of the spasticity in 72.4% of the cases and to improved motor capacities in 65.5% of the cases. Post-operative complications were few, consisting of talus foot in 2 cases and dysaesthesias of the foot on the plantar aspect in 3 cases. This study shows that SN is able to take its place in the surgical armamentarium for treating disabling localized spasticity when it cannot be successfully controlled by rehabilitation and medical therapy. An appropriate candidate selection and intensive postoperative rehabilitation are mandatory to obtain good and long lasting results.