title: Surgical outcomes of microsurgical selective peripheral neurotomy for intractable limb spasticity.
abstract: BACKGROUND
  The authors frequently employed selective peripheral neurotomy (SPN) as the primary treatment of severe intractable focal and multifocal spastic hypertonia. We occasionally operated SPN in diffuse spastic disorders.
  
  
  OBJECTIVE
  To study surgical outcome of SPN in terms of severity of spasticity and functional condition.
  
  
  METHODS
  Patients harboring refractory harmful spasticity of various origins were enrolled into the present study. They were clinically evaluated by using the Modified Ashworth Scale (MAS), passive range of motion (PROM) and functional status. These variables were compared between pre- and postsurgery by using the paired t test and the Wilcoxon signed-rank matched-pairs test.
  
  
  RESULTS
  One hundred and forty-one SPNs were accomplished in 33 patients. Overall mean pre- and postoperative MAS and PROM were 3.0 and 0.7 (p < 0.001) and 78.3 and 102.3° (p < 0.001), respectively. Analysis of individual SPN subgroups also demonstrated statistically significant improvement of both parameters. Furthermore, we found significant gait improvement among 10 ambulatory subjects. Nine bed-bound cases attained significant enhancement of sitting competency and ambulatory condition.
  
  
  CONCLUSIONS
  SPN is an efficacious neurosurgical intervention in the treatment of spasticity. It is apparently beneficial in the reduction of spasticity, amelioration of functional status, facilitation of patient care and prevention of long-term musculoskeletal sequelae.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. bunpotsi@yahoo.com
authors.forename: Bunpot
authors.initials: B
authors.lastname: Sitthinamsuwan
authors.forename: Kannachod
authors.initials: K
authors.lastname: Chanvanitkulchai
authors.forename: Luckchai
authors.initials: L
authors.lastname: Phonwijit
authors.forename: Sarun
authors.initials: S
authors.lastname: Nunta-Aree
authors.forename: Witsanu
authors.initials: W
authors.lastname: Kumthornthip
authors.forename: Teerada
authors.initials: T
authors.lastname: Ploypetch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005121:Extremities / Q000294:innervation* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009128:Muscle Spasticity / Q000175:diagnosis / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010525:Peripheral Nerves / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult