Efficacy of selective neurotomy for focal lower limb spasticity: a systematic review.
Danique J M Ploegmakers, Hanneke J R Van Duijnhoven, Liron S Duraku and 3 others
PMID 39254381WHAT IT FOUND
Selective neurotomy reduced leg muscle tone in 95% of treated patients and often improved walking speed and pain.
However, 25 of 26 included studies were low quality with high risk of bias, so these results are not yet reliable evidence that the surgery works.
Key findings
01Muscle tone decreased in 95% of participants across four studies that reported individual outcomes, and mean tone scores dropped to 2 or lower in all nineteen studies that measured it.
02Seven of thirteen studies reported a statistically significant increase in comfortable walking speed, and none of the thirteen reported a decrease.
03Twenty-five of the twenty-six included studies scored as low quality on methodological assessment, indicating a high risk of bias.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Twenty-five of the 26 studies were rated as low quality with a high risk of bias. There were almost no randomised controlled trials, so it is impossible to compare the surgery against other treatments or no treatment reliably. Outcome measures varied widely between studies, preventing direct comparison or meta-analysis. Complications and side effects were poorly reported in most studies. The review included a mix of adults and children (ages 4–83), so results may not apply equally to all groups.
The easy way to misread this
Do not interpret the reported improvements in walking speed and tone as proof that selective neurotomy is effective. The vast majority of the evidence comes from uncontrolled case series where patients improved over time for reasons unrelated to the surgery, and the authors explicitly state the level of evidence is limited.