Does fascicular neurotomy have long-lasting effects?

Objective: To determine whether fascicular neurotomy has long-lasting effects on spasticity. Design: We present 4 clinical cases and a critical analysis of the literature. Patients: This is a retrospective study on 4 patients referred to our department for spastic equinovarus foot deformity. For all 4, neurotomy was successful not long after surgery, but spasticity reappeared after a few months. Methods: We compared our results with those in the PubMed database. Results: Most publications acknowledge the immediate effectiveness of this surgery, but do not study the long-term effects of neurotomy. No publication proved long-lasting effects of neurotomy for spastic equinovarus foot deformity. The only long-term follow-up with a sufficient population is the one of Berard et al. ( Pediatr Orthop B 1998, 7: 66), who reported 61% recurrence. Conclusion: There is no study showing that tibial nerve neurotomy has long-lasting effects. The 4 cases reported are an illustration that recurrence of spasticity may occur after neurotomy. These findings have to be taken into account for treatment decision-making and for provision of information to patients.