Utilization of electromyography during selective obturator neurotomy to treat spastic cerebral palsy accompanied by scissors gait.

Songtao Ren,Chang-Li Guo ,Weidong Liu,Li Wang,Qi Pang

doi:10.31083/j.jin.2019.03.146

Abstract

Selective obturator neurotomy is a commonly used neurosurgical intervention for spastic cerebral palsy with scissors gait. Here we report the use of surface electromyography to assess the accuracy and effect of selective obturator neurotomy procedures. Selective obturator neurotomy was carried out on 18 patients while using intraoperative electromyography. Contractions of adductor muscles were recorded by electromyography before and after neurotomy and assessed using root mean square and integrated electromyography tests. Passive and voluntary movements were recorded for all patients. Our results show that adductor spasms and adductive deformity of hip were improved in all patients with spastic cerebral palsy. Adductor muscle spatiality was improved significantly, confirmed by a significant decrease in the values of root mean square and integrated electromyography in both passive and voluntary movements after surgery. We show that electromyography is an effective tool for accurately and safely targeting nerve tracts during selective obturator neurotomy. Thus, we demonstrate a valuable noninvasive method to objectively evaluate the effect of treatment in spastic cerebral palsy patients.

Highlights

Cerebral palsy is a diverse group of disorders caused by permanent but not progressive damage in the developing brain
Other remedies rely on selective obturator neurotomy (SON), including focal injection of botulinum toxin, focal application of alcohol or phenol, and intrathecal injection of baclofen (Ploumis et al, 2014)
3.2 root mean square (RMS) and integrated electromyography (iEMG) values RMS and iEMG values decreased significantly after surgery when compared to pre-operation (P < 0.05)

Summary

Introduction

Cerebral palsy is a diverse group of disorders caused by permanent but not progressive damage in the developing brain. Muscle spasms constitute one of the most common manifestations of cerebral palsy (Bell et al, 2002). There are multiple methods to treat spastic cerebral palsy, the primary goal being to reduce muscular tension and eliminate spasticity. Most patients are treated with medication and physical rehabilitation (Abbruzzese, 2002). Other remedies rely on selective obturator neurotomy (SON), including focal injection of botulinum toxin, focal application of alcohol or phenol, and intrathecal injection of baclofen (Ploumis et al, 2014). Botulinum toxin type A, in conjunction with appropriate physical therapy, is used against focal dystonia and rigidity in hemiplegic spasticity (Yan et al, 2018)

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Conclusion