Hyperselective neurectomy for spastic equinovarus in pediatric patients with hypertonia

PurposeLower extremity spasticity can cause pain and limit function. This study examined the safety and efficacy of hyperselective neurectomy (HSN) of the gastrocnemius-soleus complex (GSC) in addressing spastic equinus deformities in pediatric patients.MethodsPediatric patients that underwent HSN of the GSC by a single surgeon were retrospectively reviewed. Preoperative and postoperative Modified Ashworth Score and passive ankle dorsiflexion (°) were compared using Wilcoxon signed-rank test and Student's paired two-tailed t-test, respectively.ResultsTen lower extremities in seven patients with a mean age of 10 years were reviewed. Mean follow-up was 15 months. All extremities demonstrated improvement in spasticity. All exhibited improved passive ankle dorsiflexion range of motion with the knee in extension (mean change +17°, SD = 8°, p = 0.000). Five patients demonstrated improved passive dorsiflexion with the knee in flexion while two remained unchanged from preoperative assessment (mean change +13°, SD = 9°, p = 0.002). One complication, wound dehiscence, was noted and managed conservatively. No patients reported loss of strength or sensation. Four patients underwent subsequent staged surgery on the ipsilateral extremity for concomitant contractures.ConclusionHSN of the GSC is safe in pediatric patients and effectively reduces spastic equinus deformity and improves ankle passive dorsiflexion in short-term follow-up.