title: Utilization of intraoperative electromyography for selecting targeted fascicles and determining the degree of fascicular resection in selective tibial neurotomy for ankle spasticity.
abstract: BACKGROUND
  Selective tibial neurotomy (STN) is an effective neurosurgical intervention for treating ankle spasticity. The authors use intraoperative electromyography (EMG) for selecting targeted fascicles and determining the degree of fascicular resection in STN. This study reports surgical techniques and outcomes of the operation.
  
  
  METHODS
  Participants who underwent STN with utilization of intraoperative EMG were recruited. Modified Ashworth Scale (MAS), passive range of motion (PROM) of the ankle in plantar flexion and dorsiflexion, Massachusetts General Hospital Functional Ambulatory Classification (MGHFAC) and ability to attain full plantigrade stance were assessed pre- and postoperatively.
  
  
  RESULTS
  Twenty-one STNs were performed in 15 patients. The mean pre- and postoperative MAS and PROM were 2.8 and 0.4 (p < 0.001), 39.5(o) and 66.0(o) (p < 0.001), respectively. The mean level of MGHFAC was improved from 3.3 preoperatively to 4.9 postoperatively (p < 0.01). Six non-ambulators had significant amelioration in MGHFAC level. Postoperatively, 19 of 21 lower limbs achieved full plantigrade, and 6 patients could perform selective voluntary motor control of the ankle.
  
  
  CONCLUSIONS
  STN is an effective procedure for spastic ankle in well-selected cases. Intraoperative EMG helps in selection of targeted fascicles, increases objectivity in neurotomy and prevents excessive denervation.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Siriraj, Bangkok, Bangkok Noi, 10700, 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: Teerada
authors.initials: T
authors.lastname: Ploypetch
authors.forename: Witsanu
authors.initials: W
authors.lastname: Kumthornthip
authors.forename: Sarun
authors.initials: S
authors.lastname: Nunta-Aree
mesh_terms: D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D000843:Ankle Joint / Q000294:innervation / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D011184:Postoperative Period; D013977:Tibia / Q000503:physiopathology / Q000601:surgery*; D013979:Tibial Nerve / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult