Neurotomía periférica selectiva en el tratamiento de la espasticidad discapacitante del niño y adolescente / Peripheral selective neurotomy in the treatment of the disabling spasticity in child and adolescent

ABSTRACT

Abbreviations PSN Peripheral Selective Neurotomy;SEF Spastic Equinus Foot;SHA Spastic Hip Adduction;SHW Spastic Hand-Wrist Introduction.PSN is a microsurgical partial section of motor branches whose aim is supress the monosinaptic tonic stretching reflex leading to reduction of harmful spasticity without excessive paresis, restoring the tonic agonist-antagonist balance in a limb segment.Aims. Assess the benefits of PSN for treatment of disabling spasticity in children and teenager population. Method.19 consecutive patients (68 por ciento males,age 5-23 ), were treated through PSN.10 patients had SEF or SHA, and 9 had SHW.The inclusion criteria were age of 4 years or more; focused disabling spasticity at least grade 2 in Ashworth Mod. Scale; failure of previous non-surgical therapies; duration of spasticity more than 2 years, positive response to the motor anaesthetic block test; no evidence of irreductible muscle contracture. The goals of surgery were to improve function, cosmetics and confort of the affected limb segment. Clinical evaluation of spasticity (Ashworth Modified Scale), articular mobility (Goniometry), Gait (Video and gait analysis), and Prehension (Functional 440 pts. Scale), were performed. Results.The postoperative follow-up period range from 1 to 18 months. Spasticity was reduced in all the muscles denervated. The triceps surae spasticity reduction in SEF patients remain stable over a follow-up period of 6-18 months. 7/9 SEF patients improved ankle active dorsiflexion, ½ SHA improved hip abduction, while a mean improvement of 31.3° in wrist supination and 28.7° in wrist extension was achieved in the SHW group. 8/9 SEF patients showed improvement in 1 or more of the following gait features ankle dorsiflexion, length of step, gait speed, proximal kinematic segment performance. The prehension improved in 7 patients (78 por ciento).All SHW patients improved their confort and limb cosmetics. 3 patients 15 por ciento) had transient dysesthesia...