title: [Palliative surgical treatment of spastic paralysis in the lower extremity].
abstract: OBJECTIVE
  The purpose of this paper is to describe our experience with and to review the best results in the surgical treatment of patients suffering from spastic paralysis of the lower limbs.
  
  
  METHODS
  To enable a correct indication of the techniques to be employed the authors recommend a thorough examination of the types of deformity (fixed, dynamic or mixed) and the use of specific tests for exploring the different deformities. These are necessary steps to be able to interpret the different disorders in a global manner and thus reach diagnostics that provide us with a proper surgical therapeutic orientation about the spastic hip, knee, ankle and foot. Due to the importance of the overall problem, it is becoming increasingly more frequent to advise multidisciplinary work involving the collaboration of different specialists (neurologists, rehabilitators, physiotherapists, psychologists, paediatricians, neurophysiologists and orthopaedic surgeons). Spasticity is as heterogeneous as the results of the different treatment projects. The techniques used must allow the rehabilitation therapy to be continued. Surgical intervention is recommended when the damage to the CNS has stabilised and the patient is over 4 years old. The psychic state of the patient and the family must also be evaluated.
  
  
  CONCLUSIONS
  The objective of the treatment in patients who can walk is to improve motor functioning, the type of gait and to prevent fixed deformities from developing. In patients who do not walk, the aim is to improve their hygiene and their capacity to sit and to walk. These indications are indispensable to be able to successfully perform a little-known area of orthopaedic surgery which does not respond to the techniques used in flaccid paralysis surgery.
authors.affiliation: Facultad de Medicina, Universidad Miguel Hernandez, San Juan, España. fernando.lopez@umh.es
authors.forename: F
authors.initials: F
authors.lastname: López-Prats
authors.forename: S
authors.initials: S
authors.lastname: Suso-Vergara
authors.forename: P
authors.initials: P
authors.lastname: Fernández-de Retana
authors.forename: P
authors.initials: P
authors.lastname: Gutiérrez-Carbonell
mesh_terms: D006801:Humans; D035002:Lower Extremity / Q000473:pathology* / Q000601:surgery; D009128:Muscle Spasticity / Q000601:surgery*; D019635:Neurosurgical Procedures; D019637:Orthopedic Procedures; D010166:Palliative Care; D010243:Paralysis / Q000601:surgery*