Selective musculocutaneous fasciculotomy for spastic elbow in cerebral palsy: a preliminary study.
Three hundred and ten people with cerebral palsy who had spasticity in one or more limbs underwent selective motor fasciculotomy (SMF) of the nerves supplying the harmful spastic muscles with the aim of achieving useful tone and to improve voluntary movements. Among them, 52 people (average age 9.5 years) had 75 spastic elbows who were considered fit cases to undergo SMF of the musulocutaneous nerve (MCN). The nerve was dissected in the upper 1/3rd of the arm. Bipolar current was used to stimulate the component fascicles and to detect those carrying excessive impulses. Some of the hyperactive fascicles were ablated according to preoperative grading of the spasticity, etc. Total relief in spasticity was achieved in 47 (62.66%) elbows. Whereas, in the remaining 28 (37.33%) elbows some degree of spasticity persisted. There were overall beneficial effects of SMF on the motor functions and the flexed elbow posture. There were no side effects and recurrence of spasticity. The results were observed for an average period of 17 months. It must be noted that, 5 people who had involuntary elbow flexion on activity, like walking, also developed normal posture and the to & fro swinging movements following surgery. In conclusion, SMF of MCN is an effective and safe procedure for achieving longlasting useful tone and voluntary movements in the harmful spastic elbow of people with cerebral palsy. The present report is an account of the largest number of cerebral palsy people in the world literature to date.
Purohit
A K
AK
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India.
Raju
B S
BS
Kumar
K S
KS
Mallikarjun
K D
KD
D000293:Adolescent; D000328:Adult; D001132:Arm / Q000601:surgery; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D004550:Elbow / Q000294:innervation / Q000601:surgery*; D004558:Electric Stimulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods / Q000592:standards; D016343:Monitoring, Intraoperative; D009121:Muscle Denervation / Q000379:methods / Q000592:standards; D009128:Muscle Spasticity / Q000601:surgery*; D009138:Musculocutaneous Nerve / Q000601:surgery*; D009412:Nerve Fibers / Q000502:physiology; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D016896:Treatment Outcome