Hyperselective neurectomy for spastic equinovarus in pediatric patients with hypertonia.
Lainey G Bukowiec, Kitty Y Wu, Joline E Brandenburg and 1 others
PMID 41100540WHAT IT FOUND
In seven children with spastic foot deformity, nerve surgery targeting calf muscles, sometimes with posterior tibial nerve surgery and physical therapy, lowered spasticity and improved ankle motion; no strength loss was reported.
Key findings
01At a mean follow-up of 15 months (range: six to 24 months), all patients had decreased gastrocnemius-soleus complex Modified Ashworth Scale scores after calf nerve surgery; four lower extremities in three patients also had posterior tibialis nerve surgery, and patients had postoperative physical therapy.
02Passive ankle dorsiflexion improved by a mean of 17° with the knee extended (SD = 8°, p = 0.00009) and 13° with the knee flexed (SD = 9°, p = 0.002) after the combined surgical and physical therapy care.
03No patients exhibited a reduction in dorsiflexion or plantarflexion strength after the combined surgical and physical therapy care; one minor complication of wound dehiscence was managed without antibiotics, and one patient had early sensory loss that resolved.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only ten lower extremities in seven patients were reviewed, so the results cannot be generalised. Follow-up was short, with a mean of 15 months and a range of six to 24 months. The study was retrospective and had no control group, so changes cannot be confidently attributed to the surgery. Outcome assessments were done by the treating surgeon without blinding. Four lower extremities in three patients had concurrent partial motor neurectomy of the posterior tibialis, and patients had postoperative physical therapy, so the effect of any single component cannot be separated. Two patients had prior muscle-tendon surgery, and four patients had later muscle-tendon surgery. The nerve procedure alone is hard to judge. The Modified Ashworth Scale is subjective and has variable inter-rater reliability. Postoperative dynamic electromyography and gait analysis were not obtained.
Declared interests
The authors received no financial support for the research, authorship, and/or publication of this article, and declared no potential conflicts of interest.
The easy way to misread this
Do not read the motion gains as proof that calf nerve surgery alone works. Only ten lower extremities in seven patients were reviewed without a control group, four lower extremities in three patients had concurrent posterior tibialis nerve surgery, and patients had postoperative physical therapy. Gross Motor Functional Classification System levels did not change.
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