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Hyper-selective neurectomy for knee flexion spasticity: anatomic bases and surgical technique
Mohammadreza Emamhadi1,2, Babak Alijani3, Mohammad Haghani Dogahe4
1Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran. emamhadi42@yahoo.com.
Purpose:
Spasticity may result from damage to neurons of the corticospinal tracts and loss of inhibitory supraspinal influences following head trauma. Traditionally, peripheral nerve surgeries for spasticity in lower limbs were limited to selective neurectomies. Here we used hyper-selective neurectomy (HSN) to release hamstring spasticity at the muscle spindle level.
Methods:
This study describes anatomic bases and surgical technique of HSN and its results in treating spastic knee flexion in a 23-year-old male who developed severe spasticity following severe brain injury. The spasticity was prominent in the left knee. The surgical technique including resection of over one centimeter of three-quarters of the overstimulated nerve rami at the entry point of the nerve into the muscle is shown in the video 1.
Results:
After the surgery Visual Analog Scale and Modified Ashworth Score reduced from 7 to 3 and 4 to 1, respectively. Popliteal angle improved from 118° to 73° at the second months after the surgery.
Conclusion:
Hyper-selective neurectomy is a safe and reliable therapeutic option for the treatment of permanent trauma induced spasticity in the lower limb.
