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Cadaveric study to assess the feasibility of S1 neurectomy and contralateral S1 transfer for spastic hemiparesis
Pawan Agarwal1, Sanat Nivasarkar2, Natwar Agrawal3
1Head, Plastic Surgery Unit, Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India.
Purpose:
Acquired brain injury causing spasticity, pain and loss of function is a major cause of disability and lower quality of life. Sacral 1 (S1) neurectomy claims promising outcomes in spastic hemiparesis. This cadaveric study was conducted to study the surgical anatomy, surgical approach and feasibility of S1 neurectomy and contralateral S1 (cS1) transfer.
Methods:
This study was conducted over a period of 10 months and 10 cadavers (age 18-60 years, 7 male and 3 female) were included in the study. 2 cadavers underwent endoscopic S1 neurectomy and 8 cadavers underwent open S1 neurectomy. Mean S1 root length and diameter were recorded using Schirmer tear strips and Vernier calliper. Feasibility of transfer was also assessed by measuring the length of donor nerve and distance between distal ends to proximal end of recipient nerve.
Results:
Mean thickness of right S1 root was 4.02 ± 1.5 mm and left S1 was 3.89 ± 1.18 mm. Mean length of right S1 root was 24.9 ± 4.56 mm and left S1 was 23.6 ± 2.86 mm. Endoscopically dissected length of S1 was much less as compared to open technique.
Conclusion:
S1 neurectomy is simple procedure to reduce spasticity in lower limb without any permanent deficit. It can be done by open as well as with endoscopic approach while for contralateral S1 transfer open approach need to be used.
