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  4. Adductor tenotomy and selective obturator neurectomy for the treatment of spasticity in a man with paraplegia

Adductor tenotomy and selective obturator neurectomy for the treatment of spasticity in a man with paraplegia

The Journal of Spinal Cord Medicine, 2013 · DOI: 10.1179/2045772312Y.0000000022 · Published: January 1, 2013

Spinal Cord InjuryNeurologyRehabilitation

Simple Explanation

Excessive hip adductor spasticity in patients with spinal cord injury (SCI) can cause the thighs to scissor, which can interfere with daily activities. If noninvasive treatments don't work, surgery might be an option. One surgical option is adductor tenotomy and selective obturator neurectomy, which involves cutting the adductor tendon and selectively cutting a nerve to reduce spasticity. This procedure relieved adductor spasticity in both thighs of a patient with T11 paraplegia, and with rehabilitation, he showed enhanced functional independence.

Study Duration
Not specified
Participants
A 22-year-old man with SCI T11 ASIA “A”
Evidence Level
Case report

Key Findings

  • 1
    Adductor spasticity was identified as the main barrier in functional activities and rehabilitation of the patient.
  • 2
    Selective obturator neurectomy and adductor tenotomy completely relieved the patient's adductor spasticity without complications.
  • 3
    The patient achieved functional indoor ambulation using orthosis despite complete paraplegia.

Research Summary

Severe adductor spasticity can significantly hinder the rehabilitation of patients with spinal cord injuries. Surgical treatment for adductor spasticity can be considered when noninvasive treatments fail to provide relief. Relief from adductor spasticity can improve functional outcomes and reduce patient dependency.

Practical Implications

Improved Functional Outcomes

Surgical intervention, specifically adductor tenotomy and selective obturator neurectomy, can lead to significant improvements in functional independence and mobility for individuals with SCI experiencing severe adductor spasticity.

Alternative Treatment Option

This surgical approach offers a viable alternative when conservative management, such as medications and physical therapy, proves ineffective in managing adductor spasticity in SCI patients.

Cost-Effective Solution

In resource-limited settings, this surgical option may provide a long-term, cost-effective solution for managing focal spasticity compared to treatments requiring frequent follow-up and adjustments.

Study Limitations

  • 1
    Case report provides limited generalizability
  • 2
    Lack of long-term follow-up data
  • 3
    Procedure requires careful patient selection

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