Efficacy of neuro-othopaedic surgery for distal lower limb spastic deformities : a retrospective study about 161 patients.
Ms Anne Laure SEICHEPINEa, Prof Christian FONTAINEb, Dr Michel-Yves GRAUWINb, Dr Nadia BUISSETc, Ms Nadine NACHEFb, Dr Marc ROUSSEAUXd, Prof André THEVENONe, Dr Etienne ALLARTd
a CHRU de Lille, b CHRU de Lille - Service d'orthopédie B, c CHRU de Lille - Service de neurochirurgie fonctionnelle, d CHRU de Lille - Service de rééducation neurologique cérébrolésion, e CHRU de Lille - Service de MPR
Objective: Distal lower limb deformities are frequent after a central nervous system lesion, and have a significant impact on posture, gait and activity. This study aimed at analyse neuro-orthopaedics procedures performed in such indications, considering their timing, their main functional objectives and their global efficacy on gait and walking conditions.
Methods: One hundred sixty one adult patients were assessed at the spasticity multidisciplinary consultation of Lille University hospital and then operated on in 2012 and 2013. Data were analysed retrospectively and included disease history, main functional objectives, nature of surgical procedures and their timing of realization and finally a qualitative analysis of analytic and functional results at the end of the treatment (with a one year post-surgery period).
Results: Patients presented with consequences of stroke (57.8%), traumatic brain injury (11.8%), cerebral palsy (9.3%); median post-lesion period was 3.5 years. The objective for patients was an improvement of gait (94.4%) and transfer (7,5%), and a reduction in walking aids (6.8%). Ninety six patients (59.6%) were operated on twice; in this case, the first surgical phase consisted most of time in neurotomies, the second one in tendinous and articular procedures. At the end of the treatment, goals were totally reached in 2/3 of patients and at least in part in 30% of them. Kinematic abnormalities during gait (equinus, varus, valgus, toe claws) were clearly improved. Finally, the need of assistance when walking or making transfers and the need for orthotics were significantly reduced.
Discussion: This study confirms the efficacy of neuro-orthopaedic treatment of distal lower limb spastic deformities on gait and walking conditions. Efficacy on activities, participation and quality of life remains to be studied.
Keywords : Spasticity; neurotomy; tendon lengthening, gait, neuro-orthopaedic surgery, stroke