[Peripheral neurotomy in the treatment of spasticity. Indications, techniques and results in the lower limbs].
BACKGROUND
The aim of this study was to review the principle of peripheral neurotomy for the treatment of lower limb spasticity. The importance of clinical assessment is stressed (with particular focus on motor block) for determining the best surgical indications.


METHODS
Between 1989 and 1997, 392 neurotomies were performed in 277 patients in the neurosurgery department of the Henri Mondor Hospital, Créteil, France. Surgical technique consisted in partial and segmental resection, involving each motor collateral branch of muscles with excessive spasticity. For the lower limb, the most frequent neurotomy was performed on collateral branches of the posterior tibial nerve (66%) for the spastic foot.


RESULTS
Preoperative motor block provided the advantage of "mimicking" the effect of the neurotomy and therefore gave the patients an idea of the expected result of surgery. For the spastic foot, posterior neurotomy led to the disappearance of ankle clonus in all patients. When antagonist muscles were present, splints were no longer needed after neurotomy. Cinematic analysis showed that tibial neurotomy improved angular variations of the second rocker of the ankle during stance.


CONCLUSIONS
Peripheral neurotomies are simple and safe procedures for the treatment of lower limb spasticity and should be routinely used in general neurosurgery practice.
Decq
P
P
Service de Neurochirurgie, Hôpital Henri-Mondor, Créteil.
Cuny
E
E
Filipetti
P
P
Fève
A
A
Kéravel
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007866:Leg / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D010525:Peripheral Nerves / Q000601:surgery*; D013979:Tibial Nerve / Q000601:surgery
Les neurotomies périphériques dans le traitement de la spasticité. Indications, technique et résultats aux membres inférieurs.