Selective Tibial Neurotomy Research Articles

Electrophysiological modifications of reflex excitability, and ankle stiffness after selective soleus lidocaine block, and after selective tibial neurotomy

Electrophysiological modifications of reflex excitability, and ankle stiffness after selective soleus lidocaine block, and after selective tibial neurotomy

Selective Tibial Neurotomy in the Treatment of Spastic Equinovarus Foot

To objectively assess the decrease in spasticity and the improvement in gait after tibial nerve neurotomy performed to treat spastic equinovarus foot. Before-after trial with a 2-yr follow-up. Three hemiplegic patients with spastic equinovarus foot were treated with a selective peripheral neurotomy of the tibial motor nerve branches (soleus, lateral and medial gastrocnemius and tibialis posterior nerves). Evaluation included clinical assessment of spasticity (Ashworth scale), maximal Hoffmann reflex (H(max))/compound muscle action potential (M(max)) ratio measurement, gait analysis, and muscle stiffness evaluation performed before and 2 mos, 1 yr, and 2 yrs after the neurotomy. Spasticity, muscle stiffness, and H(max)/M(max) ratio decreased after neurotomy. The kinematic (ankle dorsal flexion and knee recurvatum) and kinetic variables (maximum ankle muscle moment and external work) of the gait were permanently improved after neurotomy. Interestingly, kinetic variables seemed to gradually improve with time after the neurotomy. Tibial neurotomy is an effective and durable treatment for spastic equinovarus foot.

Long term course of the H reflex after selective tibial neurotomy

Objectives: This study was conducted to evaluate the long term clinical and electrophysiological outcome by recording the H reflex in a consecutive series of six patients treated by selective tibial...

Analyse préliminaire 3D de la marche de l’hémiplégique : rôle de la flexion du genou dans la stratégie de récupération fonctionnelle

Objective. – The aim of this preliminary study was to assess strategies of walking a stride in stroke patients with spastic right hemiplegia. Material and methods. – Gait was recorded in 3D in seven patients without other locomotion disorders. Kinematics data were studied only on the sagittal plane. The position and trajectory markers on the right side were studied during the swing phase in comparison with static standing position. Results were confronted with angular data. Results. – Three walking models were defined: 1) near normal gait with normal mobility in the knee; 2) gait with hicking while the flexion of the knee was reduced; 3) gait with a “talus” foot without motor recovery necessitating a pendular movement. Discussion. – The second pathological group was characterized with insufficient flexion in the knee in lifting the foot from the floor. In this group, patients adopted a compensation strategy with hicking in making the stride without touching the floor. We raised the question of limiting this adaptive strategy in order to enhance their remaining mobility. Conclusion. – A 3D strategy gait analysis, before therapeutic choices, seems to confirm the value of analysing kinematic data in stroke patients with hemiplegia. The amplitude of knee mobility and hip compensation strategy can be specifically studied to improve the effectiveness of therapeutic strategies (orthesis, selective tibial neurotomy, botulinum toxin).

Intérêt de l’analyse tridimensionnelle de la marche, dans la prise en charge du pied spastique

Introduction. – The purpose of this work is to assess the interest of three dimensional gait analysis in measuring the effect of orthesis and of selective tibial neurotomy without visual analysis. Method. – After clinical examination, gait in the two groups was recorded by a three dimensional motion system ( Vicon-Oxford Metrics) with free velocity. The gait of ten stroke patients was compared bare-foot and with ankle-foot orthesis. The gait of nine stroke patients was compared bare-foot before and six month after selective tibial neurotomy. Kinematics data were studied in the sagittal plane, and muscular electrical activity was detected on the affected side by a ten-channel telemetry system using surface electrodes. An analogic visual scale ( EVA) was used by the patient, to assess discomfort during walking. Results. – In the “orthesis” group, calf spasticity was 2.5 on the Ashworth scale. With ankle-foot orthesis, the walking discomfort on EVA was significantly reduced from 4.25 to 1.16. Gait speed increased significativelly at 0.42 m s –1 to 0.59 m s –1. In swing phase, equinus disappeared. In stance phase equinus and recurvatum were controlled, anterior pelvic tilt decreased and hip extension increased. In the “neurotomy” group, 6 months after the tibial neurotomy, calf spasticity decreased from 3.4 to 0. The walking discomfort on EVA, was significantly reduced from 5.97 to 3.6. Gait speed increased from 0.51 m s –1 to 0.54 m s –1. Ankle dorsiflexion on the affected side, was possible during stance for five patients and residual motricity was released during swing phase for two patients. Stance knee recurvatum was corrected in five patients. Conclusion. – Three dimensional analysis specifies the functional gait disability in stroke patients. It specifies the degree of correction provided by orthesis or tibial neurotomy in the various gait cycle phases and the impact on the superior joints.

Physiological effects of selective tibial neurotomy on lower limb spasticity

OBJECTIVESTo assess by electrophysiology the effect of tibial selective neurotomy on muscle imbalance of the spastic ankle.METHODThe amplitudes of the H reflexes, M responses (muscle contractions recorded after stimulation of...

Microsurgical Ablative Procedures in the Peripheral Nerves and Dorsai Root Entry Zone for Relief of Focal Spasticity in the Limbs

When spasticity is harmful and localized in the limb(s), ablative procedures in the peripheral nerves or the dorsal root entry zone (DREZ) can be useful. The authors report on the long-term results of (1) selective tibial neurotomy in a series of 62 spastic feet, and (2) microsurgical DREZ-tomy in a series of 69 patients affected with hyperspasticity in the entire upper or lower limb(s).

Selective neurotomy of the tibial nerve for treatment of the spastic foot.

One of the most frequent neurological sequelae seen by the specialist in rehabilitation is the spastic foot. Spasticity in the foot may be responsible for abnormal posture and painful or trophic disturbances impairing standing and walking. This disability can be corrected by a simple neurosurgical procedure, the selective tibial neurotomy. In this procedure, one sections the tibial nerve branches to the muscles sustaining spasticity, i.e., the soleus and/or the gastrocnemius nerves for equinus and ankle clonus or the posterior tibialis branch for varus and the flexor fascicles for tonic flexion of the toes. After microsurgical dissection of each tibial nerve branch at the lower part of the popliteal region and their identification with bipolar electrostimulation, the selected branches are partially sectioned under the operating microscope. The present series consists of 62 operations performed in 53 patients, 9 bilaterally and 44 unilaterally. Operation obtained complete suppression of the disabling spasticity that had been present for 2 to 17 years (4 on average), total pain relief, and consequently improvement of the residual voluntary movements (by achieving a better balance between agonist and antagonist muscles) in 51 of the 62 spastic feet (i.e., 82% of the cases). For all of these patients, the beneficial effects were long-lasting over the 1- to 10-year follow-up (3 years on average). Selective neurotomy of the tibial nerve should be considered only after failure of intensive prolonged kinestherapy and of all available medical treatment. It must take place, however, before the onset of irreversible articular disturbances and musculotendinous retractions, which require complementary orthopedic corrections.