Applied anatomy study and preliminary clinical application of hyper selective neurectomy of triceps branches combined with partial neurotomy of S<sub>2</sub> nerve root to relieve spastic equinus foot_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Ke ^1,2 , YIN Yaobin ^1,2,3 , WANG Shufeng ^1,2,3 , LI Feng ^1,2,3 ,  LI Wenjun ^1,2,3,4,5

1. Department of Hand Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, P. R. China;
2. The 4th Medical College of Peking University, Beijing, 100035, P. R. China;
3. Beijing Research Institute of Traumatology and Orthopaedics, Beijing, 100035, P. R. China;
4. Department of Neuroelectrophysiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, P. R. China;
5. Beijing Orthopedics Professional Quality Control and Improvement Center, Beijing, 100035, P. R. China;

Corresponding author：

LI Wenjun, Email: dcliwenjun@163.com

Keywords：

Spastic paralysis; equinus foot; hyper selective neurectomy; S₂nerve root neurotomy

DOI：

10.7507/1002-1892.202404012

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Objective To observe the possibility of hyper selective neurectomy (HSN) of triceps branches combined with partial neurotomy of S₂ nerve root for relieving spastic equinus foot. Methods Anatomical studies were performed on 12 adult cadaveric specimens. The S₂ nerve root and its branches were exposed through the posterior approach. Located the site where S₂ joined the sciatic nerve and measured the distance to the median line and the vertical distance to the posterior superior iliac spine plane, and the S₂ nerve root here was confirmed to have given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. Between February 2023 and November 2023, 4 patients with spastic equinus foot were treated with HSN of muscle branches of soleus, gastrocnemius medial head and lateral head, and cut the branch where S₂ joined the sciatic nerve. There were 3 males and 1 female, the age ranged from 5 to 46 years, with a median of 26 years. The causes included traumatic brain injury in 2 cases, cerebral hemorrhage in 1 case, and cerebral palsy in 1 case. The disease duration ranged from 15 to 84 months, with a median of 40 months. The triceps muscle tone measured by modified Ashworth scale (MAC) before operation was grade 3 in 2 cases and grade 4 in 2 cases. The muscle strength measured by Daniels-Worthingham manual muscle test (MMT) was grade 2 in 1 case, grade 3 in 1 case, and 2 cases could not be accurately measured due to grade 4 muscle tone. The Holden walking function grading was used to evaluate lower limb function and all 4 patients were grade 2. After operation, triceps muscle tone, muscle strength, and lower limb function were evaluated by the above grading. Results The distance between the location where S₂ joined the sciatic nerve and median line was (5.71±0.53) cm and the vertical distance between the location and posterior superior iliac spine plane was (6.66±0.86) cm. Before joining the sciatic nerve, the S₂ nerve root had given off branches of the pelvic splanchnic nerve, the pudendal nerve, and the posterior femoral cutaneous nerve. All the 4 patients successfully completed the operation, and the follow-up time was 4-13 months, with a median of 7.5 months. At last follow-up, the muscle tone of the patients decreased by 2-3 grades when compared with that before operation, and the muscle strength did not decrease when compared with that before operation. Holden walking function grading improved by 1-2 grades, and there was no postoperative hypoesthesia in the lower limbs. Conclusion HSN of triceps branches combined with partial neurotomy of S₂ nerve root can relieve spastic equinus foot without damaging other sacral plexus nerves.

Citation： XU Ke, YIN Yaobin, WANG Shufeng, LI Feng, LI Wenjun. Applied anatomy study and preliminary clinical application of hyper selective neurectomy of triceps branches combined with partial neurotomy of S₂ nerve root to relieve spastic equinus foot. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(8): 1010-1015. doi: 10.7507/1002-1892.202404012 Copy

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1. Nielsen JB, Crone C, Hultborn H. The spinal pathophysiology of spasticity—from a basic science point of view. Acta Physiol (Oxf), 2007, 189(2): 171-180.
2. Centers for Disease Control and Prevention. What is cerebral palsy? [EB/OL]. [2024-03-03]. https://www.cdc.gov/ncbddd/cp/facts.html.
3. Brashear A, Elovic E. Spasticity: diagnosis and management. 2nd ed. New York: Demos Medical Publishing, 2011: 10-11.
4. Wissel J, Manack A, Brainin M. Toward an epidemiology of poststroke spasticity. Neurology, 2013, 80(3 Suppl 2): S13-S19.
5.
6. Rodda J, Graham HK. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol, 2001, 8 Suppl 5: 98-108.
7.
8.
9.
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28.
29.
30. Preston DC, Shapiro BE. Electromyography and neuromuscular disorders: clinical-electrodiagnostic-ultrasound correlations. 4th ed. Canada: Elsevier, 2020: 194-196.

Chinese Journal of Reparative and Reconstructive Surgery

Applied anatomy study and preliminary clinical application of hyper selective neurectomy of triceps branches combined with partial neurotomy of S₂ nerve root to relieve spastic equinus foot

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Applied anatomy study and preliminary clinical application of hyper selective neurectomy of triceps branches combined with partial neurotomy of S2 nerve root to relieve spastic equinus foot

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Applied anatomy study and preliminary clinical application of hyper selective neurectomy of triceps branches combined with partial neurotomy of S₂ nerve root to relieve spastic equinus foot