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Selective peripheral neurotomy (SPN) for spasticity in childhood
M P Sindou1, F Simon, P Mertens
1Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Université Claude-Bernard Lyon I, 59 Bd Pinel, 69003, Lyon, France. marc.sindou@chu-lyon.fr
Summary
Selective peripheral neurotomy effectively treats severe focal spasticity in children when other treatments fail. This neurosurgical procedure offers significant benefits for managing debilitating muscle overactivity.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
Background:
- Excess spasticity causes significant disability, including impaired locomotion and deformities.
- Severe focal spasticity in children often necessitates surgical intervention when treatments like botulinum toxin injections are insufficient.
Purpose of the Study:
- To outline the indications and methods for selective peripheral neurotomy in managing focal spasticity.
- To highlight the role of preoperative motor blocks in defining neurotomy objectives.
Main Methods:
- Selective peripheral neurotomy targets specific nerves to alleviate focal spasticity.
- Procedures include obturator neurotomy (adductors), hamstring neurotomy (knee flexion), tibial neurotomy (foot), anterior tibial neurotomy (hallux), and femoral neurotomy (quadriceps).
- Upper limb neurotomies address shoulder internal rotation, elbow flexion, and wrist/finger pronation/flexion.
Main Results:
- Preoperative motor blocks are crucial for determining surgical goals.
- Specific neurotomies are indicated for various spastic muscle groups in the lower and upper limbs.
Conclusions:
- Selective peripheral neurotomy is a valuable neurosurgical option.
- The procedure is highly effective for severe, focal spasticity when performed by experienced surgeons.
