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

Objective :

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.

Methods :

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.

Results :

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.

Discussion :

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