Microsurgical Selective Obturator Neurotomy for Spastic Hip Adduction.

Park, Yeul Bum; Kim, Seong Ho; Kim, Sang Woo; Chang, Chul Hoon; Cho, Soo Ho; Jang, Sung Ho

Original Article

Journal of Korean Neurosurgical Society 2007;41(1): 22-26.

Yeul Bum Park, Seong Ho Kim, Sang Woo Kim, Chul Hoon Chang, Soo Ho Cho, Sung Ho Jang

¹Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea. shkim@med.yu.ac.kr
²Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Korea.

ABSTRACT

OBJECTIVE
Cerebral palsy may induce harmful spastic hip adduction. We report the result of microsurgical selective obturator neurotomy, performed on 12 spastic hip adductions of 6 patients, followed clinically for at least 26 months postoperatively.
METHODS
Microsurgical selective obturator neurotomies, involving microsurgical resection of the anterior obturator nerve branches were performed on 6 patients from January 2000 through June 2003. All patients presented with the inability to sit and 2 patients complained of persistent, intractable pain. We used intraoperative bipolar stimulation to identify selected motor branches.
RESULTS
The procedure was performed bilaterally in all patients. In the 3 patients in whom contractures were present, microsurgical selective obturator neurotomies were accompanied by an additional tenotomy of the adductor muscles. Selective tibial neurotomy was performed on three of six patients who originally presented with a spastic ankle. Postoperatively, all spastic hip adductions were corrected more than 60 degrees in passive abduction-adduction amplitude. However, one patient who did not receive active postoperative physiotherapy demonstrated a decreased passive abduction-adduction amplitude upon follow-up. There were no surgical complications.
CONCLUSION
We think microsurgical selective obturator neurotomy may be an effective procedure in the treatment of localized, harmful spastic hip adduction after failure of well conducted conservative treatment. As muscular contractions are often associated with spasticity of the hip adductors, an adjunctive tenotomy may be an option. Comprehensive postoperative physiotherapy is essential to improve long-term results.

Key Words: Cerebral palsy; Spasticity; Hip adduction; Microsurgical seletive obturator neurotomy