Direct neurectomy of the motor branches of the tibial nerve in hemiplegic adults: An assessment with a mean follow-up period of 11 years.
Summary of "Direct neurectomy of the motor branches of the tibial nerve in hemiplegic adults: An assessment with a mean follow-up period of 11 years."
INTRODUCTION:
Neurectomy of the tibial nerve plays a major role in the relief of disabling spasticity, which is refractory to drug treatment and physiotherapy. Although the immediate postoperative results are generally satisfactory, few evaluations of the procedure's long-term efficacy have been published.
OBJECTIVE:
To estimate the long-term efficacy of total or partial neurectomy of the motor branches of the tibial nerve (combined with additional orthopaedic surgery in some cases).
METHOD:
A descriptive, retrospective study of 25 brain-damaged patients having undergone neurectomy at least 4 years ago.
RESULTS:
The mean post-neurectomy follow-up period was 11 years. Twenty patients became less dependent on the use of walking aids. Of the 18 patients unable to walk barefoot before surgery, 11 could do so after surgery. Of the 12 patients unable to walk on uneven ground before surgery, seven could do so afterwards. The walking distance increased for 20 patients. In 22 cases, the spasticity disappeared immediately after the operation and did not reappear in the long-term. In three other cases, spasticity persisted postoperatively and, in the long-term, affected the soleus (the denervation of which had been incomplete or not performed). Eighty-three percent of the patients were satisfied with the operation's outcome.
CONCLUSIONS:
The observed maintenance of the benefits of total or partial neurectomy after an average follow-up period of 11 years confirms the value of this procedure. The few mediocre outcomes (observed in cases of partial neurectomy of the soleus) are in agreement with literature reports and emphasize the role of the soleus in this pathology.
Affiliation
CRMPR Les Herbiers, 111, rue Herbeuse, 76230 Bois-Guillaume cedex, France.
Journal Details
This article was published in the following journal.
Name: Annals of physical and rehabilitation medicine
ISSN: 1877-0665
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20634165
- DOI: http://dx.doi.org/10.1016/j.rehab.2010.06.001
Medical and Biotech [MESH] Definitions
Sciatic Nerve
A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the TIBIAL NERVE and the PERONEAL NERVE.
Tibial Nerve
The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot.
Tibial Neuropathy
Disease of the TIBIAL NERVE (also referred to as the posterior tibial nerve). The most commonly associated condition is the TARSAL TUNNEL SYNDROME. However, LEG INJURIES; ISCHEMIA; and inflammatory conditions (e.g., COLLAGEN DISEASES) may also affect the nerve. Clinical features include PARALYSIS of plantar flexion, ankle inversion and toe flexion as well as loss of sensation over the sole of the foot. (From Joynt, Clinical Neurology, 1995, Ch51, p32)
Laryngeal Nerves
Branches of the VAGUS NERVE. The superior laryngeal nerves originate near the nodose ganglion and separate into external branches, which supply motor fibers to the cricothyroid muscles, and internal branches, which carry sensory fibers. The RECURRENT LARYNGEAL NERVE originates more caudally and carries efferents to all muscles of the larynx except the cricothyroid. The laryngeal nerves and their various branches also carry sensory and autonomic fibers to the laryngeal, pharyngeal, tracheal, and cardiac regions.
Peroneal Nerve
The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot.
PubMed Articles
Introduction: We investigated the clinical utility of single fiber conduction velocity (SF-CV) testing in the evaluation of motor nerve function in diabetic patients with signs and symptoms of symmetr...
PURPOSE: The superficialis to profundus (STP) tendon transfer is an effective procedure to correct a spastic clenched fist deformity in a nonfunctional upper extremity. An intrinsic thumb-in-palm (TIP...
We studied changes in orofacial behavior and the arrangement of bilateral hypoglossal nuclei after the neurectomy of the medial branch of the unilateral hypoglossal nerve in cats. After recovery from...
Motor branching patterns of the ulnar nerve in the forearms of fetal cadavers.
PURPOSE: The aim of this study was to investigate the branches of the ulnar nerve given to forearm muscles [flexor carpi ulnaris (FCU) and flexor digitorum profundus (FDP)] and typing of ulnar nerve a...
During development neurons form supernumerary synapses, most of which are selectively pruned leading to stereotyped patterns of innervation. During the development of skeletal muscle innervation, or i...
Clinical Trials
Tibial Nerve Stimulation for Faecal Incontinence
The purpose of this study is to determine whether tibial nerve stimulation is an effective treatment for faecal incontinence.
Nerve blocks are an effective way to control pain after surgery. There are two major nerves that provide sensation to the knee: the femoral nerve provides sensation to the front of the kne...
Percutaneous Tibial Nerve Stimulation for Patients With Fecal Incontinence
Percutaneous tibial nerve stimulation is introduced as regular treatment option for fecal urge continence at the Cantonal Hospital St. Gallen. During this introduction phase efficiency und...
Posterior Tibial Nerve Stimulation vs. Sham
The overall goal of this research is to determine the efficacy of a sham for posterior tibial nerve stimulation (PTNS). This novel design is needed in order to have a sham treatment that i...
Elective Neurectomy During Inguinal Hernia Repair
Chronic inguinal neuralgia is one of the most important complications following inguinal hernia repair. It may even outweigh the benefit of the operation. Intraoperative neurectomy has be...
