PERIPHERAL NEUROTOMY FOR THE TREATMENT OF SPASTICITY - INDICATIONS, TECHNIQUE AND OUTCOME IN THE LOWER-LIMBS

Introduction. - The aim of this study was to review the principle of p eripheral neurotomy for the treatment of lower limb spasticity. The im portance of clinical assessment is stressed (with particular focus on motor block) for determining the best surgical indications. Material a nd method. - Between 1989 and 1997, 392 neurotomies were performed in 277 patients in the neurosurgery department of the Henri Mondor Hospit al, Creteil, France. Surgical technique consisted in partial and segme ntal resection, involving each motor collateral branch of muscles with excessive spasticity. For the lower limb, the most frequent neurotomy was performed on collateral branches of the posterior tibial nerve (6 6 %) for the spastic foot. Results. - Preoperative motor block provide d the advantage of << mimicking >> the effect of the neurotomy and the refore gave the patients an idea of the expected result of surgery. Fo r the spastic foot, posterior neurotomy led to the disappearance of an kle clonus in all patients. When antagonist muscles were present, spli nts were no longer needed after neurotomy. Cinematic analysis showed t hat tibial neurotomy improved angular variations of the second rocker of the ankle during stance. Conclusion. - Peripheral neurotomies are s imple and safe procedures for the treatment of lower limb spasticity a nd should be routinely used in general neurosurgery practice.