Combined selective peripheral neurotomy for treatment of spasticity in lower limbs of cerebral palsy patients

Objective To study the surgical outcome and safety of combined selective peripheral neurotomy (SPN) for treatment of spasticity in lower limbs of cerebral palsy patients. Methods A total of 109 cerebral palsy patients with lower limb spasticity (218 limbs) were treated with combined SPN on bilateral obturator nerve, tibial nerves and sciatic nerves from March 2007 to March 2017 at Department of Neurosurgery, Linyi Traditional Chinese Medicine Hospital. The modified Asworth scale (mAS) was used for the evaluation of the patients’ spasticity and their movement ability was assessed by the gross motor function classification system (GMFCS). Results The mean follow-up period was 73.6±16.7 months (range: 12-132 months). The spasticity was alleviated in 209 (95.9%) lower limbs immediately post surgery, and the rate of alleviation was 90.8% (198 limbs) at the last follow-up. The mAS scores of adductor muscle of hip and ankle metatarsal flexor muscle were 2.66±0.49 and 3.36±0.52 respectively prior to surgery and 1.52±0.46 and 1.57±0.56 respectively at last follow-up. Those differences were statistically significant (P<0.01). At the last follow-up, 95 of 109 (87.2%) had improvement on motor function. There was significant improvement on motor function indicated by elevated GMFCS scales (P<0.05). The sensory disorder of limb was found in 51 (23.4%) lower limbs, decreased muscle strength occurred in 39 (17.9%) lower limbs during hospitalization, and both complications were improved during the follow-up period. Conclusions Combined SPN on bilateral obturator nerve, tibial nerves and sciatic nerves was an effective and safe method for the treatment of lower limb spasticity and improvement of lower limb movement in cerebral palsy patients who cannot undergo selective posterior rhizotomy (SPR) due to various reasons or those whose spasticity cannot be completely relieved after SPR. Key words: Muscle spasticity; Cerebral palsy; Neurosurgical procedures; Peripheral nerves; Child