Surgery in the Peripheral Nerves for Lower Limb Spasticity

Abstract

Introduced by Stoffel in 1912 for the treatment of spastic foot drop, selective neurotomy consists of partial section of the motor branches to the muscles causing excessive spasticity. This peripheral surgery for spasticity is based on two main concepts. First, spinal reflexes and muscles are heterogeneous, and their regional organization depends on their role during normal movements. This fact is the physiological basis for focal spasticity and peripheral treatment. Second, there is a differential reinnervation after partial section, leading to motor recovery without spindle reinnervation (therefore without spasticity). A careful clinical assessment must be conducted before a neurotomy is performed. What kind of spasticity does the patient have? What is the goal (functional or comfort)? Surgery can be mimicked by motor nerve blocks (anesthetic drugs) to give patients an idea of the expected surgical outcome. Many types of neurotomies have been described for the lower and upper limbs, depending on the patient’s clinical status. The most common neurotomy is the tibial neurotomy for spastic foot drop.