Short-term Outcomes of Hyperselective Neurectomy for Lower Extremity Spasticity in Pediatric Patients with 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: Seven pediatric patients met inclusion criteria (two male, five female with a mean age of 10 years) with varying underlying diagnoses (six with cerebral palsy and one with hereditary spastic paraparesis). Bilateral procedures (performed on three patients) were counted as separate procedures. The mean follow-up was 9 months (range 2 to 15 months). All patients demonstrated improved plantarflexion MAS scores at most recent follow up, with a mean pre-operative ankle plantarflexion MAS of 3.0 which decreased to a mean of 0.6 post-operatively. Mean preoperative ankle dorsiflexion ROM with the knee in extension was -9° which slightly worsened to a mean of -13° postoperatively. With the knee in 90° flexion, ankle dorsiflexion improved from a mean of -6° preoperatively to a mean of 5° postoperatively. The only complication was wound dehiscence, noted for only one patient.
CONCLUSIONS: HSN of the GSC is safe in pediatric patients. 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 in a pediatric population.
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