Highly Selective Partial Neurectomy for Lower-Extremity Spasticity: 2-Dimensional Operative Video.

Area of Science:

• Neurology
• Neurosurgery
• Orthopedic Surgery

Background:

• Spasticity, a common consequence of central nervous system injury, significantly impacts quality of life.
• Current treatments like medications and botulinum toxin injections offer limited efficacy and potential side effects.
• Selective neurectomy presents a surgical alternative for sustained tone reduction.

Observation:

• A 23-year-old woman with severe spastic diplegia due to cerebral palsy experienced persistent lower extremity spasticity despite multiple prior interventions.
• The patient presented with crouch gait, adductor scissoring, and bilateral equinovarus, significantly impairing her mobility.
• Previous successful hamstring and obturator neurectomies motivated the consideration of tibial neurectomies.

Findings:

• Selective neurectomies of the tibial nerve motor fascicles targeting the gastrocnemius, soleus, and tibialis posterior muscles were performed.
• The surgical technique involved precise fascicular dissection to achieve partial neurectomy.
• Postoperatively, the patient demonstrated a significant reduction in spasticity (Modified Ashworth Scale 3 to 0) and improved gait, with preserved motor power.

Implications:

• Selective neurectomy is a highly effective procedure for managing focal extremity spasticity, offering a durable solution.
• Further clinical studies are warranted to define optimal indications, assess long-term durability, and quantify risks and benefits.
• This case highlights the potential of selective neurectomy as a valuable therapeutic option for refractory spasticity.