EFFICACY OF SINGLE STAGE MULTILEVEL SOFT TISSUE RELEASE BY PERCUTANEOUS NEEDLE TECHNIQUE FOR SPASTIC CONTRACTURES OF LOWER LIMBS IN CEREBRAL PALSY

Abdulmonem M. Alsiddiky, SSC-Orth*, Khalid A. Bakarman, ABOS, Kholoud O. Alzain, SSC-Orth, Zulqurnain Rafiq, FCP, Ibrahim Alshaygy, SSC-Orth, Fahad Alhuzaimi, SSC-Orth, Waleed Awwad, FRCSC, Abdel Rahman M. Zamzam, MSc and Muhammed Asif, FCPS

ABSTRACT

Background: Single-stage multi-level percutaneous tenotomy and tendon lengthening using scalpel is a frequently used procedure in lower limbs for spastic cerebral palsy (CP). This study was performed to assess the outcome of single-stage multilevel percutaneous needle tenotomy and tendon lengthening among CP patients. Methods: A retrospective study was performed to analyze the data of all patients who were known to have Cerebral palsy and underwent percutaneous needle muscle-tendon surgery at authors’ institute during the period between January 2005 and January 2012. We excluded patients with extrapyramidal system involvement, those requiring bony correction or taking anti-spasticity therapy and cases with incomplete information. All patients were followed up regularly for at least 4 years. Results: There were 174 patients, 98 males (56.3%) and 76 females (43.7%). The mean age at time of surgery was 7.4 years ± 3.1 (range, 2 to 13). There was no major complications. Minor bleedings were reported in 39 patients (22.4%). 97 patients had hip affection. Recurrence of hip adduction deformity occurred in 19 patients (19.6%). Fixed flexion deformity of the knee was managed in 152 patients. Recurrence of deformity occurred in 47 knees (16.7%). Hyperextension or recurvatum deformity occurred in 14 knees (5%). There was equinus deformity of the ankle in 135 patients. Recurrence of equinus occurred in 33 ankles (13%). The postoperative improvement of hip, knee and ankle motions was found significant statistically (p< 0.0001) at final follow up. Conclusion: Percutaneous needle tenotomy and tendon lengthening proved to be safe and effective minimally invasive surgical approach for spastic contractures in the lower limbs. Our results support using this technique when performing single stage multilevel surgical releases in CP patients to achieve improvement in function and hygiene.

Keywords: percutaneous, needle, tenotomy, spasticity, cerebral palsy.