Selective Neurotomy of the Tibial Nerve for the Treatment of the Spastic Foot: Case Report.
- Author:
Hun CHANG
1
;
Sung Whan CHO
;
Moon Chan KIM
;
Joon Ki KANG
;
Myeong Ki LEE
;
Dae Jo KIM
Author Information
1. Department of Neurosurgery, Kang Nam St. Mary's Hospital, Catholic University, College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Selective neurotomy;
Tibial nerve;
Spastic foot
- MeSH:
Anesthetics;
Foot*;
Humans;
Microdissection;
Muscle Spasticity*;
Neurosurgical Procedures;
Posture;
Quality of Life;
Sensation;
Tibial Nerve*;
Walking
- From:Journal of Korean Neurosurgical Society
1996;25(10):2136-2141
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
When the spasticity becomes wevere and hamful, in spite of physical and medical therapy, surgery can give functional improvement. The authors report two cases of selective neurotomy of the tibial nerve for the treatment of the spastic foot which led to abnormal posture, articular limitation, pain, and disturbances impairing standing and walking. Prior to surgery, the effectiveness of neurotomy had been verified by means of infiltrating the nerves with local anesthetic agents. The surgery was performed under the intraoperative electrostimulation for identifying the branches of tibial nerve to the muscle sustaining spasticity. After microdissection of each tibial nerve brance at the lower part of the popliteal region, the selected branches were cut, preserving at least one fourth of the motor fibers. Significant functional gains were observed as a result of substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory function. For patients with disabling spastic foot, refractory to routine physical, orthopaedic and medical treatment a simple neurosurgical procedure, the selective tibial neurotomy has enabled them to stand and walk comfortably, and has allowed them to reach a significantly improved quality of life.
