Surgical outcomes of microsurgical selective peripheral neurotomy for intractable limb spasticity

Abstract

© 2013 S. Karger AG, Basel. Background: The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of severe intractable focal and multifocal spastic hypertonia. We occasionally operated SPN in diffuse spastic disorders. Objective: To study surgical outcome of SPN in terms of severity of spasticity and functional condition. Methods: Patients harboring refractory harmful spasticity of various origins were enrolled into the present study. They were clinically evaluated by using the Modified Ashworth Scale (MAS), passive range of motion (PROM) and functional status. These variables were compared between pre-and postsurgery by using the paired t test and the Wilcoxon signed-rank matched-pairs test. Results: One hundred and forty-one SPNs were accomplished in 33 patients. Overall mean pre-and postoperative MAS and PROM were 3.0 and 0.7 (p < 0.001) and 78.3 and 102.3° (p < 0.001), respectively. Analysis of individual SPN subgroups also demonstrated statistically significant improvement of both parameters. Furthermore, we found significant gait improvement among 10 ambulatory subjects. Nine bed-bound cases attained significant enhancement of sitting competency and ambulatory condition. Conclusion: SPN is an efficacious neurosurgical intervention in the treatment of spasticity. It is apparently beneficial in the reduction of spasticity, amelioration of functional status, facilitation of patient care and prevention of long-term musculoskeletal sequelae.