Abstract
INTRODUCTION
Tibial Selective Motor fasiculotomy involves ablation of hyperexcitable tibial nerve fasicles, which help in reduction of spasticity in ankle plantr flexors
METHODS
This prospective cohort study included 14 children with cerebral palsy, age ranging from 5–18 (mean 10.21) years and M: F ratio is 5:1 having spasticity in the lower limbs. All the children were assessed pre and post operatively by Modified Ashworth Scale (MAS), Selective Voluntary Control (SVC) grade and locomotor Abilities (kneel walking, squat to stand, standing and walking). Tibial SMF was performed (n = 23) for relief of spasticity in ankle plantar flexors in 14 children and were followed for a mean of 30 (6-60) months. All the children were given physical therapy pre and post operatively.
RESULTS
>During a mean follow up (30 months) there was statistically significant reduction in spasticity (MAS, P < 0.005) from1.92 to 0.31 in ankle plantar flexors. Pre and post operative SVC grade also improved from 2.65 to 3.35 in ankle plantar flexors (p > 0.005). There were no complications and spasticity did not recur during follow up. 9 children required Z plasty simultaneously to relieve the contracture.
CONCLUSION
The Tibial SMF of tibial nerves significantly relieves spasticity in the ankle plantar flexors and thereby improves SVC equinous deformity and motor abilities in children having cerebral palsy. It is quite a safe procedure and the spasticity does not recur during a mean follow up of 30 months.
Outcome of caudal lumbosacral selective posterior rhizotomy in the management of spastic diplegia due to cerebral palsy (a prospective cohort study in 35 children)
