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01-06-2013 | Clinical Article - Functional

Utilization of intraoperative electromyography for selecting targeted fascicles and determining the degree of fascicular resection in selective tibial neurotomy for ankle spasticity

Authors: Bunpot Sitthinamsuwan, Kannachod Chanvanitkulchai, Luckchai Phonwijit, Teerada Ploypetch, Witsanu Kumthornthip, Sarun Nunta-aree

Published in: Acta Neurochirurgica | Issue 6/2013

Abstract

Background

Selective tibial neurotomy (STN) is an effective neurosurgical intervention for treating ankle spasticity. The authors use intraoperative electromyography (EMG) for selecting targeted fascicles and determining the degree of fascicular resection in STN. This study reports surgical techniques and outcomes of the operation.

Methods

Participants who underwent STN with utilization of intraoperative EMG were recruited. Modified Ashworth Scale (MAS), passive range of motion (PROM) of the ankle in plantar flexion and dorsiflexion, Massachusetts General Hospital Functional Ambulatory Classification (MGHFAC) and ability to attain full plantigrade stance were assessed pre- and postoperatively.

Results

Twenty-one STNs were performed in 15 patients. The mean pre- and postoperative MAS and PROM were 2.8 and 0.4 (p < 0.001), 39.5^o and 66.0^o (p < 0.001), respectively. The mean level of MGHFAC was improved from 3.3 preoperatively to 4.9 postoperatively (p < 0.01). Six non-ambulators had significant amelioration in MGHFAC level. Postoperatively, 19 of 21 lower limbs achieved full plantigrade, and 6 patients could perform selective voluntary motor control of the ankle.

Conclusion

STN is an effective procedure for spastic ankle in well-selected cases. Intraoperative EMG helps in selection of targeted fascicles, increases objectivity in neurotomy and prevents excessive denervation.

Bleyenheuft C, Detrembleur C, Deltombe T, Fomekong E, Lejeune TM (2008) Quantitative assessment of anaesthetic nerve block and neurotomy in spastic equinus foot: a review of two cases. J Rehabil Med 40:879–881PubMed

Bohannon RW, Smith MB (1987) Inter-rater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67:206–207PubMed

Bollens B, Deltombe T, Detrembleur C, Gustin T, Stoquart G, Lejeune TM (2011) Effects of selective tibial nerve neurotomy as a treatment for adults presenting with spastic equinovarus foot: a systematic review. J Rehabil Med 43:277–282PubMedCrossRef

Buffenoir K, Roujeau T, Lapierre F, Menei P, Menegalli-Boggelli D, Mertens P, Decq P (2004) Spastic equinus foot: multicenter study of the long-term results of tibial neurotomy. Neurosurgery 55:1130–1137PubMedCrossRef

Decq P, Filipetti P, Cubillos A, Slavov V, Lefaucheur JP, Nguyen JP (2000) Soleus neurotomy for treatment of the spastic equinus foot. Groupe d'Evaluation et de Traitement de la Spasticité et de la Dystonie. Neurosurgery 47:1154–1160PubMedCrossRef

Decq P, Filipetti P, Feve A, Djindjian M, Saraoui A, Kéravel Y (1997) Peripheral selective neurotomy of the brachial plexus collateral branches for treatment of the spastic shoulder: anatomical study and clinical results in five patients. J Neurosurg 86:648–653PubMedCrossRef

Decq P, Shin M, Carrillo-Ruiz J (2005) Surgery in the peripheral nerves for lower limb spasticity. Oper Tech Neurosurg 7:136–146CrossRef

Holden MK, Gill KM, Magliozzi MR (1986) Gait assessment for neurologically impaired patients. Standards for outcome assessment. Phys Ther 66:1530–1539PubMed

Lorenz F (1887) Uber cirurgische Behandlung der angeborenen spastischen Gliedstarre. Wien Klin Rdsch 21:25–27

10.

Mertens P (2009) Neurosurgery for spasticity. In: Sindou M (ed) Practical handbook of neurosurgery from leading neurosurgeons. Springer Wien, New York, pp 365–386

11.

Rousseaux M, Buisset N, Daveluy W, Kozlowski O, Blond S (2009) Long-term effect of tibial nerve neurotomy in stroke patients with lower limb spasticity. J Neurol Sci 278:71–76PubMedCrossRef

12.

Sindou M, Mertens P (2009) Destructive neurosurgical procedures for spasticity. In: Lozano AM, Gildenberg PL, Tasker RR. Textbook of stereotactic and functional neurosurgery. Springer-Verlag Berlin Heidelberg, pp 1935-1957CrossRef

13.

Sindou MP, Mertens P (2005) Decision-making for neurosurgical treatment of disabling spasticity in adults. Oper Tech Neurosurg 7:113–119CrossRef

14.

Sindou MP, Simon F, Mertens P, Decq P (2007) Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst 23:957–970PubMedCrossRef

15.

Sitthinamsuwan B, Chanvanitkulchai K, Phonwijit L, Nunta-aree S, Kumthornthip W, Ploypetch T (2012) Improvement of sitting ability and ambulation status after selective peripheral neurotomy of the sciatic hamstring nerve together with obturator branches for severe spasticity of the lower extremities. Stereotact Funct Neurosurg 90:335–343PubMedCrossRef

16.

Sitthinamsuwan B, Nunta-aree S (2010) Functional peripheral nerve surgery. Siriraj Med J 62:106–111

17.

Sitthinamsuwan B, Nunta-Aree S, Nitising A, Tabtimsuwan S (2010) The neurosurgical treatment of spasticity—an overview. Neurol Surg 1:44–60CrossRef

18.

Sitthinamsuwan B, Parnnang C, Nunta-Aree S, Chankaew E, Papatthanaporn A (2010) An innovation of intraoperative electrical nerve stimulator. Neurol Surg 1:65–82CrossRef

19.

Sitthinamsuwan B, Phonwijit L, Nunta-aree S (2012) Current advance in neurosurgery for the peripheral nerve—Part I: fundamental anatomy, intraoperative nerve monitoring and classification of peripheral nerve surgery. Neurol Surg 3:33–48CrossRef

20.

Sitthinamsuwan B, Phonwijit L, Ploypetch T (2011) Neurosurgical management for cerebral palsy—part I: neuroablation. J Thai Rehab Med 21:73–84

21.

Wangjam KB, Joy Singh AK, Romi Singh N, Nilachandra L, Bimol N (2011) EMG guided selective tibial neurectomy in reduction of gastro-soleus spasticity—its role in the treatment of cerebral palsy. Indian J Phys Med Rehabil 12:1–5

Title: Utilization of intraoperative electromyography for selecting targeted fascicles and determining the degree of fascicular resection in selective tibial neurotomy for ankle spasticity
Authors: Bunpot Sitthinamsuwan
Kannachod Chanvanitkulchai
Luckchai Phonwijit
Teerada Ploypetch
Witsanu Kumthornthip
Sarun Nunta-aree
Publication date: 01-06-2013
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 6/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-013-1686-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Utilization of intraoperative electromyography for selecting targeted fascicles and determining the degree of fascicular resection in selective tibial neurotomy for ankle spasticity

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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