| Abstract: |
Over 3-year period selected, fifty patients with intractable, handicapping lower limb spasticity were prospectively treated by selective neurotomy (group A, 35 patients) and dorsal rhizotomy (group B, 15 patients) with 6-month follow up.Objectives: This study aimed at evaluation of the results of the surgical procedures utilized. Special protocol was proposed.Patients and methods: Fifty patients suffering from intractable, handicapping spasticity affecting lower limbs were subjected to different surgical modalities for management of spasticity between June 2009 and June 2012 in a prospective study which was done at the Department of Neurosurgery, Faculty of Medicine, Zagazig and Ain Shams Universities.Results: Variable grades of improvement following surgery with no deterioration. Significant improvement with G4 and G5 noted in 34.7% of group A and 53.3% in group B, no patient after surgery had G2 or less muscle power grade after surgery. The postoperative muscle power improvement was of significant value in both groups. Marked improvement of muscle tone (modified Ashworth scale) following neurotomies and dorsal rhizotomies. All patients in both groups had normal or mild spasticity. Following surgery, the postoperative improvement in muscle tone was of significnat value in both procedures. Marked improvement of the range of the joint movewment following neurotomies and dorsal rhizotomies, the improvement rate was more than 60% of the preoperative data. The postoperative improvement was of significant value in both procedures. Improvement of ambulation and gait was noted among patients with neurotomies and rhizotomies as 51.4% of patients became ambulatory following neurotomies and in 73.3% of patients following dorsal rhizotomies. The postoperative improvement was of high significant value in both procedures. All patients had no or mild occasional pain following neurotomies and dorsal rhizotomies. The postoperative improvement of pain was of high significant value. Improvement in the functional disability (gross motor function scale) was found in 51.4% in group A and 80% in group B how had a gross motor function classification scale (4 and 5) and are able to serve themselves independently with significnat difference between the two groups. Marked reduction of the H/M ratio following neurotomies with reduction rate of 79.9% and following dorsal rhizotomies with reduction rate of 80.7% with high significnat value versus preoperatively in both procedures. The decrease of H/M rate reflects reduction of hyperexcitability, muscle tone and spasticity.Conclusion: Both neurotomies and dorsal rhizotomies utilized for alleviating symptoms of lower limb spasticity were safe surgical procedures and were provided with good improvement in respect of: muscle power, severity of spasticity, patient’s ambulation, gait, range of joint movement, associated pain, functional disability and nerve excitability (H/M ratio) with no significnat diffference between both procedures. However, neurotomies had shorter operative duration and hospital stay which is of significant value and rhizotomy leads to more improvement as regard gait and motor functions..
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