Microsurgical selective peripheral neurotomy in the treatment of spasticity in cerebral-palsy children.
Spasticity represents the most handicapping sequelae of cerebral palsy in children. In this study, 28 children with spastic cerebral palsy were treated over the last 4 years by microsurgical selective peripheral neurotomy: 28 times the posterior tibial nerve for spastic foot deformity, 3 times the ulnar and median nerves for spastic flexion of wrist and fingers, 2 times the sciatic nerve for spastic knee flexion associated with spastic foot deformity and 3 times obturator nerves for spastic adductors. Results on spasticity with follow-up ranging from 3 to 48 months were as follows: spastic foot deformity was corrected in all patients with pure spasticity, 2 out of the 3 children with ulnar and median neurotomy improved, knee flexion and hip adduction were improved in the other 5 patients. Selective peripheral neurotomy is an effective procedure in the treatment of segmental harmful spasticity after failure of a well-conducted conservative treatment associating physiotherapy and antispasmodic medications. It must be performed before the fixed deformities and other orthopedic complications arise.