Lontkovsky Y. Neurosurgical treatment of local spasticity of the muscles of the lower limbs

The research is based on results of complex examination and treatment of 155 patients with local spasticity in lower extremities, been treated in the clinic of reconstructive neurosurgery of Romodanov Neurosurgery Institute in a period from 2010 to 2012. 135 (86.45%) patients have been operated. In 3 cases consequences of disseminated encephalomyelitis were found, in 2 - spinal trauma; in 130 children (82 (63%) boys and 48 (37%) girls, an average age 5,1 years) - cerebral palsy was diagnosed. Muscles tone disorders limit skills of standing and walking, give rise to abnormal movement patterns, contractures, dislocations, resistant motor deficiency. Spasticity causes degenerative changes in muscle up to their full replacement with connective tissue. The severity of morphological changes in the spastic muscles depends on the disease duration. The scheme of diagnostic and therapeutic measures in local muscle spasticity of the lower limbs was developed. Adducent muscles miotomy and obturator nerve surface branches neurotomy was performed in 114 patients: in 18 - with hip contracture of the 2nd degree, in 65 - with the 3rd degree; in 31 patients - with the 4th degree. In the postoperative period in all patients a significant increase of active and passive movements in the joints was noted. In all cases the lower limbs crossing was removed that promoted restoration of standing and walking skills. We proposed a new effective method of neurosurgical treatment for spasticity in distal regions of lower extremities in patients with cerebral palsy - selective fascikulotomy and stitching tibial nerve motor fibers. In 9 patients with spastic cerebral palsy 14 such surgeries have been performed. In all cases tone decrease in spastic muscles was observed, in average from 3.3 to 1 points. In a period of 8-10 months after surgery 7 (71.8%) children started to walk independently, 2 (22.2%) - with a little outside support. Selective rear radicotomy - is an effective treatment for spasticity, refractory to medical treatment, combined with severe pain. Laminotomy performing in children during selective posterior radicotomy prevents spine deformation.