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Hyperselective neurectomy versus tendo-achilles lengthening for pediatric spastic equinus: A comparative cohort study
J Terrence Jose Jerome1, G Surendran1, K Thirumagal1
1Olympia Hospital & Research Centre, Trichy, Tamilnadu, India.
Background:
Spastic equinus is a common gait-limiting deformity in children with upper motor neuron disorders, particularly cerebral palsy. Surgical management has traditionally emphasized tendon-lengthening procedures such as tendo-Achilles lengthening (TAL), which correct structural shortening but do not address the neural mechanisms underlying spasticity. Hyperselective neurectomy (HSN) of tibial motor branches has emerged as a targeted approach to reduce focal spastic overactivity.
Purpose:
To describe two sequential treatment-era cohorts managed with TAL or HSN for pediatric spastic equinus and to examine whether the observed clinical and reintervention patterns support further prospective evaluation of mechanism-based surgical selection.
Study Design:
Retrospective comparative cohort study (Level III).
Methods:
Two sequential treatment eras (2021-2023) from a single surgeon's practice were analyzed. The earlier cohort underwent TAL, whereas the later cohort underwent HSN of tibial motor branches to the gastrocnemius-soleus complex. Treatment selection emphasized clinical differentiation between dynamic and fixed equinus using passive ankle dorsiflexion, clonus assessment, and gait evaluation. Demographic variables, follow-up duration, and need for additional procedures were recorded.
Results:
Eight patients underwent TAL and ten underwent HSN. Mean age at surgery was 8.1 and 9.5 years, with mean follow-up of 26 and 23 months, respectively. Additional procedures were performed in 2 of 8 patients after TAL and 2 of 10 patients after HSN. Secondary procedures after HSN reflected staged correction of residual contracture. Clinical records documented qualitative reduction in clonus following HSN, but standardized between-group comparison was not possible.
Conclusions:
These preliminary findings suggest that distinguishing dynamic neural overactivity from fixed contracture may assist surgical selection and sequencing; they do not establish superiority or equivalence between HSN and TAL.