Selective tibial neurotomy in residual spasticity after achilles tendon orthopedic surgery in children with cerebral palsy

• Main Authors: A. Răşină, J. Ciurea, Eva Gheorghiţă, B. Bălănescu
• Format: Article
• Language: English
• Published: London Academic Publishing 2011-09-01
• Series: Romanian Neurosurgery
• Subjects: cerebral palsy; neurotomy; orthopedy; varus equin foot
• Online Access: https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/601

Objective: To prove the clinical and functional benefits of partial selective tibial neurotomy (PSTN) in residual spastic foot after orthopedic Achilles tendon surgery. Methods: A total of 12 ambulatory residual spastic children, between 8 and 16 years old, initialy operated on the Achilles tendon, was analysed using, as inclusion criteria, the evidence of the clonoidal gait and the clawing toes, the pain generating subtalar subluxation and the kinematics disturbances in the optoelectronic motion analysis. Results: Clinical improvement of the spastic foot was observed (mean gain of 1,7 on the Ashworth scale and of 1,6 on the Tardieu one) and a good post-operative goniometric result as well, in correlation with the one obtained after the pre-operative nerve block. In functional terms, PSTN is effective on the pain during the gain. Electrophysiology reflects the durability of the Hmax/Mmax ratio in post-operative period. Conclusion: The surgical procedure cannot be performed in isolation. The place of the neurosurgery and of the PSTN especially in the treatment of the spastic foot continues to be studied and refined.