[Selective peripheral neurotomy of the hamstring branches of the sciatic nerve in the treatment of spastic flexion of the knee. Apropos of a series of 11 patients].
BACKGROUND
A series of 11 patients (9 adults and 2 children) were operated on by selective peripheral neurotomy for spastic knee in flexion. The objective of surgery was to restore bipodal stance and therefore walking for the adult patients and to improve walking for the diplegic children.


METHODS
Spasticity was secondary to stroke or cranial trauma for the adult patients. The two children presented with Little disease. The delay between onset and surgery was on the average of 2 years. All the patients had a passive flexum of the knee of 20 degrees, and an excessive spasticity of the hamstrings (average Held score of 4.55). Peripheral selective neurotomies consist of a partial section of the spastic muscle's motor fascicles. The partial section concerns the afferent fibers to the spinal cord whose interruption leads to the disappearance of spasticity. The section also involves the motoneurones' axons and thus leads to partial denervation.


RESULTS
The spasticity of the treated muscles disappeared in the 11 patients. Average follow-up was 16 months. The neurotomies led to improvement of walking without splint for 3 walking patients, and restored walking with a splint for 5 patients. One patient failed to walk. The two children had a dramatic improvement of their walk.


CONCLUSIONS
Our results incite us to increasingly indicate this type of neurotomy in the treatment of the spastic lower limb.
Decq
P
P
Service de Neurochirurgie, Hôpital Henri-Mondor, Créteil.
Filipetti
P
P
Feve
A
A
Saraoui
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee / Q000294:innervation* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009128:Muscle Spasticity / Q000601:surgery*; D018482:Muscle, Skeletal / Q000294:innervation* / Q000601:surgery
Neurotomies périphériques sélectives des collatérales pour les muscles ischio-jambiers dans le traitement de la spasticité en flexion du genou. A propos d'une série de 11 patients.