TENOTOMY IN THE TREATMENT OF SPASTIC PARAPLEGIA

Abstract

A method of treatment, proposed for the correction of severe flexion deformities in spastic paraplegia, consists of multiple selected tenotomies, combined with neurotomies as indicated. Paraplegia with severe flexor spasm presents essentially a combination of hip flexion, hip adduction, and knee flexion. Hip flexion can be relieved by section of the psoas and, in the complete lesions, more easily by complete iliopsoas tenotomy; hip adduction can be relieved by extrapelvic obturator neurotomy; knee flexion can be relieved by hamstring tenotomy, with preservation of the semimembranosus in some cases where the lesion is incomplete. The flexor spasm was relieved in each of the ten cases presented, but severe extensor rigidity later developed in one. Treatment by tenotomy is selective in scope, does not interfere with visceral function, and is safe in the presence of debility or decubitus ulcers. All patients require extensive physical therapy and rehabilitation after operation, and in most cases braces are required. Destructive surgery is indicated only after maximum recovery has occurred and after more conservative measures have failed.