Journal Home > Volume 6 , Issue 1

Spasticity can be caused by central nervous system dysfunction, such as cerebral palsy and stroke. The accepted pathogenesis of spasticity is that the muscles are in the state of uninhibited stretch reflex without enough control of central nervous system. So far, there is no ideal way about how to repair central nervous system. However, the uninhibited stretch reflex can be reduced, targeting the posterior root of the spinal cord and peripheral nerves innervating the limbs, which are called selective posterior rhizotomy (SPR) and selective peripheral neurotomy (SPN), respectively. SPN is indicated for focal or multifocal spasticity, which is well accepted due to its low invasiveness and ease of use. How does the operation work? What do we do before and during this operation? Is there any risk to the patients? Our review summarizes the mechanism, indications, preoperative assessments, techniques, and complications of SPN. We hope that the spastic patients, such as pediatric cerebral palsy patients and older stroke patients, will benefit from this surgery.


menu
Abstract
Full text
Outline
About this article

Selective peripheral neurotomy (SPN) as a treatment strategy for spasticity

Show Author's information Juan Fan1Ronald Milosevic2Shijie Wang1( )
Yuquan Hosipital, Tsinghua University, Beijing 100040, China
Clinical Centre of Nis, Nis 18000, The Republic of Serbia

Abstract

Spasticity can be caused by central nervous system dysfunction, such as cerebral palsy and stroke. The accepted pathogenesis of spasticity is that the muscles are in the state of uninhibited stretch reflex without enough control of central nervous system. So far, there is no ideal way about how to repair central nervous system. However, the uninhibited stretch reflex can be reduced, targeting the posterior root of the spinal cord and peripheral nerves innervating the limbs, which are called selective posterior rhizotomy (SPR) and selective peripheral neurotomy (SPN), respectively. SPN is indicated for focal or multifocal spasticity, which is well accepted due to its low invasiveness and ease of use. How does the operation work? What do we do before and during this operation? Is there any risk to the patients? Our review summarizes the mechanism, indications, preoperative assessments, techniques, and complications of SPN. We hope that the spastic patients, such as pediatric cerebral palsy patients and older stroke patients, will benefit from this surgery.

Keywords: spasticity, selective dorsal rhizotomy (SDR), peripheral neurotomy

References(45)

[1]
G Sheean. The pathophysiology of spasticity. Eur J Neurol. 2002, 9(Suppl 1): 3-9; dicussion 53–61.
[2]
S Tabtimsuwan, B Sitthinamsuwan, E Chankaew. Spasticity: A comprehensive review. Siriraj Med J. 2011, 63: 32-37.
[3]
JMN Enslin, NG Langerak, AG Fieggen. The evolution of selective dorsal rhizotomy for the management of spasticity. Neurotherapeutics. 2019, 16(1): 3-8.
[4]
JMN Enslin, AG Fieggen. Surgical management of spasticity: CME. S Afr Med J. 2016, 106(8): 753-756.
[5]
CS Sherrington. Nobel lecture: Inhibition as a coordinative factor. http://www.nobelprize.org/nobel_prizes/medicine/laureates/1932/sherrington-lecture.html (accessed 29 June, 2016).
[6]
JB Nielsen, C Crone, H Hultborn. The spinal pathophysiology of spasticity—from a basic science point of view. Acta Physiol (Oxf). 2007, 189(2): 171-180.
[7]
MP Sindou, F Simon, P Mertens, et al. Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst. 2007, 23(9): 957-970.
[8]
F Lorenz. Uber chirurgische behandlung der angeborenen spastischen gliedstare (in German). Wien Klin Rdsch. 1887, 21: 25-27.
[9]
A Stoffel. The treatment of spastic contractures. J Bone Joint Surg. 1913, s2-10(4): 611-644.
[10]
B Sitthinamsuwan, S Nunta-Aree. Functional peripheral nerve surgery. Siriraj Med J. 2010, 62: 106-111.
[11]
B Sitthinamsuwan, S Nunta-Aree, A Nitising, et al. The neurosurgical treatment of spasticity—an overview. Neurol Surg. 2010, 1: 44-60.
[12]
B Sitthinamsuwan, L Phonwijit, T Ploypetch. Neurosurgical management for cerebral palsy. I. Neuroablation. J Thai Rehab Med. 2011, 21: 73-84.
[13]
P Decq. Peripheral neurotomies for the treatment of focal spasticity of the limbs (in French). Neurochirurgie. 2003, 49(2/3 Pt 2):293-305.
[14]
SM Salem, WF El-Saadany, WA Fouad, et al. Evaluation of selective peripheral neurotomies in the treatment of refractory lower limb spasticity in adults. Alex J Med. 2018, 54(3): 229-233.
[15]
TF Jr Winters, JR Gage, R Hicks. Gait patterns in spastic hemiplegia in children and young adults. J Bone Joint Surg Am. 1987, 69(3): 437-441.
[16]
JM Rodda, HK Graham, L Carson, et al. Sagittal gait patterns in spastic diplegia. J Bone Joint Surg Br. 2004, 86(2): 251-258.
[17]
J Rodda, HK Graham. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol. 2001, 8(Suppl 5): 98-108.
[18]
A Thibaut, C Chatelle, E Ziegler, et al. Spasticity after stroke: physiology, assessment and treatment. Brain Inj. 2013, 27(10): 1093-1105.
[19]
JK Gronley, J Perry. Gait analysis techniques. Rancho Los Amigos Hospital gait laboratory. Phys Ther. 1984, 64(12): 1831-1838.
[20]
LW Robinson, ND Clement, J Herman, et al. The Edinburgh visual gait score—The minimal clinically important difference. Gait Posture. 2017, 53: 25-28.
[21]
B Toro, CJ Nester, PC Farren. The development and validity of the Salford Gait Tool: an observation- based clinical gait assessment tool. Arch Phys Med Rehabil. 2007, 88(3): 321-327.
[22]
KG Maathuis, CP van der Schans, A van Iperen, et al. Gait in children with cerebral palsy: observer reliability of physician rating scale and Edinburgh visual gait analysis interval testing scale. J Pediatr Orthop. 2005, 25(3): 268-272.
[23]
B Ashworth. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner. 1964, 192: 540-542.
[24]
RW Bohannon, MB Smith. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987, 67(2): 206-207.
[25]
J Mehrholz, Y Major, D Meissner, et al. The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury. Clin Rehabil. 2005, 19(1): 63-72.
[26]
JM Gracies, JE Marosszeky, R Renton, et al. Short-term effects of dynamic Lycra splints on upper limb in hemiplegic patients. Arch Phys Med Rehabil. 2000, 81(12): 1547-1555.
[27]
B McDowell. The gross motor function classification system—expanded and revised. Dev Med Child Neurol. 2008, 50(10): 725.
[28]
HK Graham, P Rosenbaum, N Paneth, et al. Cerebral palsy. Nat Rev Dis Primers. 2016, 2: 15082.
[29]
R Palisano, P Rosenbaum, S Walter, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997, 39(4): 214-223.
[30]
RJ Palisano, P Rosenbaum, D Bartlett, et al. Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008, 50(10): 744-750.
[31]
SA Ross, JR Engsberg. Relationships between spasticity, strength, gait, and the GMFM-66 in persons with spastic diplegia cerebral palsy. Arch Phys Med Rehabil. 2007, 88(9): 1114-1120.
[32]
LM Avery, DJ Russell, PS Raina, et al. Rasch analysis of the Gross Motor Function Measure: validating the assumptions of the Rasch model to create an interval-level measure. Arch Phys Med Rehabil. 2003, 84(5): 697-705.
[33]
AV Dekopov, VA Shabalov, AA Tomskiĭ, et al. Microsurgical selective neurotomy in treatment of the focal spastic syndromes of the different etiology (in English, Russian). Zh Vopr Neirokhir Im N N Burdenko. 2013, 77(2): 65-72.
[34]
P Mikalef, D Power. The role of neurectomy in the management of spasticity of the upper limb. EFORT Open Rev. 2017, 2(11): 469-473.
[35]
AK Purohit, BS Raju, KS Kumar, et al. Selective musculocutaneous fasciculotomy for spastic elbow in cerebral palsy: a preliminary study. Acta Neurochir (Wien). 1998, 140(5): 473-478.
[36]
RL Waters. Upper extremity surgery in stroke patients. Clin Orthop Relat Res. 1978(131): 30-37.
[37]
J Maarrawi, P Mertens, J Luaute, et al. Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients. J Neurosurg. 2006, 104(2): 215-225.
[38]
DK Shin, YJ Jung, JC Hong, et al. Selective musculocutaneous neurotomy for spastic elbow. J Korean Neurosurg Soc. 2010, 48(3): 236-239.
[39]
KW Kwak, MS Kim, CH Chang, et al. Surgical results of selective Median neurotomy for wrist and finger spasticity. J Korean Neurosurg Soc. 2011, 50(2): 95-98.
[40]
W Fouad. Management of spastic hand by selective peripheral neurotomies. Alex J Med. 2011, 47(3): 201-208.
[41]
M Gras, C Leclercq. Spasticity and hyperselective neurectomy in the upper limb. Hand Surg Rehabil. 2017, 36(6): 391-401.
[42]
B Sitthinamsuwan, K Chanvanitkulchai, L Phonwijit, et al. Surgical outcomes of microsurgical selec-tive peripheral neurotomy for intractable limb spasticity. Stereotact Funct Neurosurg. 2013, 91(4): 248-257.
[43]
P Decq, E Cuny, P Filipetti, et al. Role of soleus muscle in spastic equinus foot. Lancet. 1998, 352(9122): 118.
[44]
K Buffenoir, T Roujeau, F Lapierre, et al. Spastic equinus foot: multicenter study of the long-term results of tibial neurotomy. Neurosurgery. 2004, 55(5): 1130-1137.
[45]
Fouad Wael. Selective neurotomy of the tibial nerve for treatment of spastic foot. Alexandria J Med. 2011, 47(4): 325-331.
Publication history
Copyright
Rights and permissions

Publication history

Received: 24 December 2019
Revised: 18 February 2020
Accepted: 20 February 2020
Published: 17 July 2020
Issue date: March 2020

Copyright

© The authors 2020

Rights and permissions

This article is published with open access at journals.sagepub.com/home/BSA

Creative Commons Non Commercial CC BY- NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/ en-us/nam/open-access-at-sage).

Return