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Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot

  • Clinical Article - Functional
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Abstract

Background

The neuromechanical consequences of tibial neurotomy have not been extensively studied.

Methods

Fifteen patients were evaluated before and after selective tibial neurotomy (after 2 months and after 15 months) by means of clinical, neurophysiological [tendon (T) reflexes, Hoffmann (H) reflexes and maximum motor response, Mmax] and mechanical parameters (passive stiffness of plantar flexors at the ankle). The neurotomy concerned the soleus (100 % of cases), gastrocnemius (20 % of cases), posterior tibial (60 % of cases) and flexor digitorum longus (47 % of cases) nerves.

Results

Neurotomy provided more than 90 % improvement of clinical spasticity scores, 20 % improvement of walking scores and the angle of passive dorsiflexion (APDF) of the ankle (mean angle: 7°), temporary reduction of the soleus Mmax (18 % at 2 months with return to the preoperative value at 15 months), and lasting reduction of the soleus Hmax/Mmax (68 % at 2 months, 78 % at 15 months) and T/Mmax (84 % at 2 months, 80 % at 15 months). M and H responses of the gastrocnemius (whether or not they were included in the neurotomy) were not modified, while T/Mmax decreased to the same degree as for soleus. Passive stiffness was lastingly decreased from 64.0 Nm/rad to 49.0 Nm/rad (2 months) and 49.5 Nm/rad (15 months).

Conclusion

Selective tibial neurotomy of the soleus nerve induces long-term reduction of reflex hyperexcitability and passive stiffness of plantar flexors in spastic patients, with no lasting impairment of motor efferents. In parallel, it modifies the tendon reflexes of synergistic muscles (gastrocnemius) not concerned by the neurotomy.

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Authors and Affiliations

  1. Université de Technologie de Compiègne UMR CNRS 7338 Biomécanique et Bioingénierie, 60319 60203, Compiègne cedex, France

    Kévin Buffenoir, Daniel Lambertz & Chantal Perot

  2. Service de Neurotraumatologie, CHU Hôtel Dieu, 1, place Alexis Ricordeau, 44093, Nantes, France

    Kévin Buffenoir & Olivier Hamel

  3. Equipe Biomécanique et Système Nerveux, Service de Neurochirurgie, Hôpital Henri MONDOR, LBM ENSAM ParisTech, Faculté de Médecine UPEC, Assistance Publique-Hôpitaux de Paris,, Créteil, France

    Philippe Decq

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  1. Kévin Buffenoir
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Correspondence to Kévin Buffenoir.

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Buffenoir, K., Decq, P., Hamel, O. et al. Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot. Acta Neurochir 155, 1731–1743 (2013). https://doi.org/10.1007/s00701-013-1770-5

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  • DOI: https://doi.org/10.1007/s00701-013-1770-5

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