Short-term Outcomes of Hyperselective Neurectomy for Lower Extremity Spasticity After Upper Motor Neuron Injury
Lainey Grey Bukowiec, MD1, Kitty Y Wu, MD1 and Peter C Rhee, DO2, 1Mayo Clinic, Rochester, MN, 2Orthopaedic Surgery, Mayo Clinic, Rochester, MN
INTRODUCTION: Lower extremity spasticity secondary to upper motor injuries can be functionally limiting with profound social implications for patients and caregivers. We hypothesized that hyperselective neurectomy (HSN) of the gastrocnemius and soleus complex (GSC) would decrease lower extremity spasticity and improve ankle dorsiflexion without decreasing strength. The aim of this study was to report on the short-term outcomes of this procedure.
MATERIALS & METHODS: Patients undergoing hyperselective neurectomy of the GSC for lower extremity spasticity from a single tertiary referral center were retrospectively reviewed. Patient demographics, pre-operative Modified Ashworth Score (MAS) for spasticity in plantarflexion, ankle range of motion (ROM), concomitant procedures, and any complications were recorded. The primary outcomes were post-operative MAS score and ankle dorsiflexion ROM.
RESULTS: 16 patients met inclusion criteria (seven male, nine female with a mean age of 44 years) with varying underlying diagnoses (ten with a history of cerebrovascular accident, one with a cervical spine injury, one with cerebral palsy, three with traumatic brain injury, one with congenital spasticity of unknown etiology). The mean follow-up was 5.68 months (range 1.50 to 16.25 months). Notably there were several patients with missing postoperative data in the electronic health record; these were excluded from the below analyses. Six out of eight patients demonstrated improved plantarflexion MAS scores at most recent follow up, one had an unchanged MAS score and one had a slightly worsened MAS score. Mean pre-operative ankle plantarflexion MAS of 2.8 improved to a mean of 0.6 post-operatively. Mean preoperative ankle dorsiflexion ROM with the knee in extension was -13° which improved to a mean of -1° postoperatively. With the knee in 90° flexion, ankle dorsiflexion improved from a mean of -3° preoperatively to a mean of 0° postoperatively. Complications included neuropraxic injury to a sensory nerve on the plantar foot, two abscesses over the popliteal fossa, two wound dehiscences, two recurrent deformities noted at follow up appointments.
CONCLUSIONS: This procedure effectively reduces spasticity in plantarflexion in short-term follow-up, with improved post-operative MAS scores and improved dorsiflexion with the knee flexed. This procedure should be examined in a larger population to more definitively determine risks and benefits associated with lower extremity hyperselective neurectomy.
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