Combined selective peripheral neurotomy in the treatment of spastic lower limbs of spinal cord injury patients

Acta Neurochirurgica, 2022 · DOI: https://doi.org/10.1007/s00701-022-05265-z · Published: June 4, 2022

Simple Explanation

Spasticity is a common complication after spinal cord injury, leading to increased muscle tension and movement disorders. Current treatments for spasticity often provide temporary relief or have intolerable side effects. Surgery is considered when these treatments fail. This study explores the effectiveness of combined selective peripheral neurotomy (cSPN) in reducing lower limb spasticity and improving motor function after spinal cord injury.

Study Duration

July 2018 to October 2021

Participants

14 spinal cord injury patients with severe lower limbs spasticity

Evidence Level

Prospective intervention (before-after trial) with an observational design

Key Findings

1
cSPN significantly reduces spasticity in the hip adductor, triceps surae, and hamstring muscles of the lower limbs.
2
The procedure leads to a significant reduction in abnormal gait patterns, specifically knee flexion and varus during standing.
3
Patients experienced significant improvements in walking ability and activities of daily living following cSPN.

Research Summary

The study investigates the therapeutic effect of combined selective peripheral neurotomy (cSPN) on lower limb spasticity in spinal cord injury patients. cSPN involves partial neurotomy of obturator, tibia, and sciatic nerve branches to reduce spasm in hip adductor, triceps surae, and hamstring muscles. The study concludes that cSPN can significantly reduce lower limb spasticity, improve abnormal gait, and enhance motor function and activities of daily living in spinal cord injury patients.

Practical Implications

Improved Motor Function

cSPN can enhance motor function and activities of daily living, which is beneficial to patients with spinal cord injuries.

Enhanced Rehabilitation

The procedure creates favorable conditions for subsequent rehabilitation training, such as gait and balance training.

Reduced Caregiver Burden

By improving patient independence, cSPN can potentially reduce the workload for caregivers.

Study Limitations

1
Small sample size for sciatic nerve SPN limits conclusions about its efficacy.
2
Lack of longer follow-up (more than 1 year) due to patient location and COVID-19.
3
The study did not find significant differences in gait parameters which may be due to insufficient rehabilitation training and short follow-up.

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