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Title: 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
Authors: Bunpot Sitthinamsuwan
Kannachod Chanvanitkulchai
Luckchai Phonwijit
Sarun Nunta-Aree
Witsanu Kumthornthip
Teerada Ploypetch
Mahidol University
Keywords: Medicine
Issue Date: 1-Oct-2012
Citation: Stereotactic and Functional Neurosurgery. Vol.90, No.5 (2012), 335-343
Abstract: Background: The authors used selective peripheral neurotomy (SPN) on the sciatic and obturator nerves to restore the sitting posture and ambulation in bedridden patients suffering from severe proximal lower limb spasticity. Objective: To study the surgical outcome of sciatic and obturator neurotomies. Methods: All patients with refractory hamstring spasticity who encountered SPN on the hamstring nerve were recruited. Obturator neurotomy was undertaken in some individuals. The clinical assessment included Modified Ashworth Scale (MAS), passive range of motion (PROM), sitting competency and ambulatory condition. These parameters were compared between before and after the surgery by using the Wilcoxon signed-rank test. Results: Among the sciatic neurotomy group (n = 15), the mean pre- and postoperative MAS and PROM were 3.3 and 0.8 (p < 0.01) and 78.3 and 121.7° (p < 0.01), respectively. Those measurements of the obturator nerve surgery group (n = 11) were 3.7 and 1.1 (p < 0.01) as well as 21.0 and 45.0° (p < 0.01), respectively. Seven and 8 of a total of 9 patients had statistically significant improvement in sitting ability (p = 0.016) and ambulation status (p < 0.01), respectively. Conclusion: Bedridden patients who suffer from severe proximal lower limb spasticity have an optimum to return to sitting and ambulate with a wheelchair after SPN of the sciatic and obturator nerves. Copyright © 2012 S. Karger AG, Basel.
ISSN: 14230372
Appears in Collections:Scopus 2011-2015

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