Selective peripheral neurotomy for limb spasticity in cerebral palsy

Abstract

Objective To investigate the candidate selection, surgical methods, efficacy and complications of selective peripheral neurotomy (SPN) for the treatment of limb spasticity in cerebral palsy. Methods A total of 119 patients with spastic cerebral palsy admitted to Department of Neurosurgery, Yuquan Hospital, Tsinghua University from January 2016 to June 2017 were enrolled into study. All those patients underwent SPN, which involved 40 upper limbs and 156 lower limbs with 360 nerves operated on. The changes of muscle tension following operation were evaluated by modified Ashworth scale and surface electromyography (sEMG). The changes of upper and lower limb motor function were evaluated by action research arm test (ARAT) and gross motor function measure (GMFM) scales. Results The immediate postoperative successful rate with limb spasticity relief was 95.6% (344/360). Moreover, the patients with Ashworth scales of 0, 1, 2, 3 accounted for 60.0% (216/360), 25.6% (92/360), 8.9% (32/360), 1.1% (4/360) respectively. Inefficient treatment accounted for 4.4% (16/360). The rate of sensory disturbance immediately post operation in the innervated region was 10.3% (37/360) and the rate of postoperative muscle strength decline over at least 1 grade was 1.9% (7/360). Sensory disturbance was all relieved within 3 months. All those patients were followed up for 6-24 (17.2±4.9) months. The improvement rate of limb motor function during follow-up was 67.3% (132/196), of which the upper limb improvement rate was 47.5% (19/40) and the lower limb improvement rate was 72.4% (113/156). Recurrence with varying degrees was reported in 32 (8.9%) cases, of which 13 (3.6%) returned to preoperative levels. Conclusions The SPN has a significant alleviating effect on the limb spasticity of cerebral palsy. Proper surgical indications and operative methods are keys to improvement of treatment efficacy and reduction of clinical complications. Key words: Cerebral palsy; Muscle spasticity; Neurosurgical procedures; Treatment outcome; Selective peripheral neurotomy