SELECTIVE PERIPHERAL NEUROTOMIES OF THE H AMSTRING BRANCHES OF THE SCIATIC-NERVE FOR THE SPASTIC KNEE IN FLEXION - A SERIES OF 11 PATIENTS

Background. A series of 11 patients (9 adults and 2 children) were ope rated on by selective peripheral neurotomy for spastic knee in flexion . The objective of surgery was to restore bipodal stance and therefore walking for the adult patients and to improve walking for the diplegi c children. Methods. Spasticity was secondary to stroke or cranial tra uma far the adult patients. The two children presented with Little dis ease. The delay betwen onset and surgery was on the average of 2 years . All the patients had a passive flexum of the knee of 20 degrees, and an excessive spasticity of the hamstrings (average Held score of 4,55 ). Peripheral selective neurotomies consist of a partial section of th e spastic muscle's motor fascicles. The partial section concerns the a fferent fibers to the spinal cord whose interruption leads to the disa ppearance of spasticity. The section also involves the motoneurones' a xons and thus leads to partial denervation. Results. The spasticity of the treated muscles disappeared in the 11 patients. Average follow-up was 16 months. The neurotomies led to improvement of walking without splint for 3 walking patients, and restored walking with a splint for 5 patients. One patient failed to walk. The two children had a dramati c improvement of their walk. Conclusion. Our results incite us to incr easingly indicate this type of neurotomy in the treatment of the spast ic lower limb.