The effect of neuro-orthopedic surgery on spasticity in patients with Stiff knee gait (SKG)

Abstract

Quadriceps femoris (QF) spasticity is frequent in patients with upper motor neuron lesion (UMNL) and SKG. Aim of this work is to study the effect of QF lengthening by functional surgery (FS) on spasticity in adults with UMNL following stroke or traumatic brain injury (TBI). A sample of 25 chronic patients with UMNL, 53 (13) years, 16/19 L/R, 6 (5) years after lesion, who underwent surgical QF lengthening was included in the study. The same surgeon always performed the surgeries. QF spasticity was assessed through the Modified Tardieu Scale (MTS) before and 1 month after surgery. MTS was used in this study as is not affected by passive muscle characteristics. Paired MTS values were compared using the non-parametric Wilcoxon test. Percentages of patients with worsened, unchanged and improved MTS scores were also computed and reported. MTS distribution is presented in Fig. 1 . Spasticity significantly decreased at 1 month after surgery ( P < 0.001). MTS score, was stable in 9 subjects (36%), improved in 16 subjects (64%) and never worsened. Noteworthy, 12 subjects (48%) were completely relieved from QF spasticity at the 1-month mark, with MTS decreasing from 3 to 0 and from 2 to 0. Along with restoring passive muscle length, FS can also be effective in reducing QF spasticity in adult stroke and TBI survivors. This is reasonably due to the reduction in spindle activation during the stretching maneuver consequent to the decrease in muscle shortening, passive tension and stiffness. Data collection is ongoing to obtain long-term results on a wider sample.