[Retrospective study of the long-term results of selective peripheral neurotomy for the treatment of spastic upper limb].
OBJECTIVE
Peripheral selective neurotomy is commonly used to treat the equinus spastic foot (tibial nerve), but is less frequently used in treating upper limb spasticity, because of the complexity of the articular deformities and the complex innervations of the different muscles. We present our experience and the long-term results of this surgery based on a retrospective series of 22 patients with a disabling spasticity of the upper limb.


METHODS
Between 2003 and 2006, neurotomies were performed in 22 patients with disabling spasticity of the upper limb despite optimal medical treatment. Patients were evaluated before and after the surgical procedure. Twelve clinical parameters were studied for describing deformity (resting position and amplitude of each joint), spasticity (Ashworth and Tardieu scores), and the functional impacts of the spasticity.


RESULTS
At long-term follow-up, all parameters were improved from the surgery, both in terms of spastic symptoms (highly significantly decreased in Ashworth and Tardieu scores) and the deformity of the upper limb (e.g., 60 degrees increase in the extension of the elbow). Pain, active amplitude, and functional impact scores were also statistically significantly improved after surgery. The mean satisfaction index was 7/10 (+/-1.6).


CONCLUSIONS
Selective neurotomy is an effective treatment for patients with a disabling and excessive spasticity in the upper limb. It provides a long-term, objective improvement based on analytical and functional parameters. We emphasize the importance of accurate clinical evaluation and surgical planning. Finally, excessive time to treatment seems to be an important factor for recurrence or incomplete efficiency of the procedure.
Buffenoir
K
K
Service de neurotraumatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France. k.buffenoir@laposte.net
Rigoard
P
P
Ferrand-Sorbets
S
S
Lapierre
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D009128:Muscle Spasticity / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010525:Peripheral Nerves / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D034941:Upper Extremity / Q000473:pathology / Q000503:physiopathology*; D055815:Young Adult