Contribution of surgical selective hyponeurotisation in the treatment of lower limbs spasticity
Dr Emna TOULGUIa, Dr Khaled MAAREFa, Dr Ines ERNEZa, Dr Sonia JEMNIa, Dr Fayçal KHACHNAOUIa, Dr Nidhal MAHDHIa
a CHU Sahloul
Surgical selective hyponeurotisation (SSH) is indicated in localized and excessive limbs spasticity. This study aims to evaluate the functional outcome of SSH on lower limbs.
Between 2011 and 2014, 26 SSH were performed in patients with localized excessive spasticity on lower limbs. Patients were selected by a careful multidisciplinary clinical evaluation including a local nerve block with an anesthetic agent. Three steps of assessment have been established; spasticity, function and pain. This evaluation was done preoperatively and postoperatively on the first day and on the third postoperative month.
The average age of patients was 38,7 ±16,5 years. The sex ratio was 2.2. The main causes of spasticity were stroke, cerebral palsy and traumatic brain injury. We noted a statistically significant decrease in spasticity assessed by the Gracies Clinical Assesment (1). The improvement was observed for all parameters , specifically for the active mobility involving antagonists ( XVA ) which contributed to statistically significant improve of the walking function at lower limbs. The pain also decreased in all patients.
Surgical selective hyponeurotisation followed by a good rehabilitation is an effective treatment for patients with excessive localized spasticity on lower limbs. It allows a decrease of spasticity and pain, and a functional improvement. This technique followed by a good rehabilitation could be a good alternative to Botulinum Toxin offering effective results with an acceptable durability and an affordable cost.
1: Gracies J, Bayle N, Vinti M, Alkandari S, Vu P, Loche C et al. Five-step clinical assessment in spastic paresis. Eur J Phys Rehabil Med. 2010;46(3):411-21.
Keywords : Neurectomy, Muscle Spasticity, Rehabilitation, Lower extremity