title: Improvement of sitting ability and ambulation status after selective peripheral neurotomy of the sciatic hamstring nerve together with obturator branches for severe spasticity of the lower extremities.
abstract: BACKGROUND
  The authors used selective peripheral neurotomy (SPN) on the sciatic and obturator nerves to restore the sitting posture and ambulation in bedridden patients suffering from severe proximal lower limb spasticity.
  
  
  OBJECTIVE
  To study the surgical outcome of sciatic and obturator neurotomies.
  
  
  METHODS
  All patients with refractory hamstring spasticity who encountered SPN on the hamstring nerve were recruited. Obturator neurotomy was undertaken in some individuals. The clinical assessment included modified Ashworth scale (MAS), passive range of motion (PROM), sitting competency and ambulatory condition. These parameters were compared between before and after the surgery by using the Wilcoxon signed-rank test.
  
  
  RESULTS
  Among the sciatic neurotomy group (n = 15), the mean pre- and postoperative MAS and PROM were 3.3 and 0.8 (p < 0.01) and 78.3 and 121.7° (p < 0.01), respectively. Those measurements of the obturator nerve surgery group (n = 11) were 3.7 and 1.1 (p < 0.01) as well as 21.0 and 45.0° (p < 0.01), respectively. Seven and 8 of a total of 9 patients had statistically significant improvement in sitting ability (p = 0.016) and ambulation status (p < 0.01), respectively.
  
  
  CONCLUSIONS
  Bedridden patients who suffer from severe proximal lower limb spasticity have an optimum to return to sitting and ambulate with a wheelchair after SPN of the sciatic and obturator nerves.
authors: Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. bunpotsi@yahoo.com
authors: Bunpot
authors: B
authors: Sitthinamsuwan
authors: Kannachod
authors: K
authors: Chanvanitkulchai
authors: Luckchai
authors: L
authors: Phonwijit
authors: Sarun
authors: S
authors: Nunta-Aree
authors: Witsanu
authors: W
authors: Kumthornthip
authors: Teerada
authors: T
authors: Ploypetch
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods* / Q000639:trends; D011187:Posture / Q000502:physiology; D012189:Retrospective Studies; D012584:Sciatic Nerve / Q000502:physiology / Q000601:surgery*; D012720:Severity of Illness Index; D016138:Walking / Q000502:physiology