{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:09Z","timestamp":1786125849880,"version":"build-2736575974"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2021,2,13]],"date-time":"2021-02-13T00:00:00Z","timestamp":1613174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Spasticity is a common debilitating condition after central nervous system injury. The principal therapies\u2014sedating antispasticity medications and focal therapies (eg, botulinum toxin)\u2014may not provide sufficient reduction in tone, have intolerable side effects, and lose efficacy over time. Selective neurectomy is a surgical option for durable reduction in tone.\n                    <jats:sup>1-6<\/jats:sup>\n                    Although commonly performed internationally, neurectomies are used less often within the USA. We present the surgical case of a 23-yr-old woman with cerebral palsy and severe spastic diplegia. Medications, injections, and tendon surgeries had failed to relieve her spastic lower extremities. She presented with crouch gait, adductor scissoring, and bilateral equinovarus. She had previously benefitted significantly from bilateral hamstring and obturator neurectomies, with improvement in mobility. She desired tibial neurectomies for her bilateral equinovarus, which impacted her gait substantially. To reduce unwanted plantarflexion and internal rotation tone, selective neurectomies of the motor nerves to the medial and lateral gastrocnemius, soleus, and posterior tibialis muscles were performed. The surgical video details a technique for longitudinally opening the epineurium, separating small nerves into their individual fascicles, and subdividing submillimeter fascicles by approximately 50% to 60% of the fascicle cross-sectional area. She reported significant improvement in gait, her modified Ashworth score dropped from 3 to 0, and her motor power remained unchanged, which is equivalent or better than most published results.\n                    <jats:sup>2,7<\/jats:sup>\n                    Neurectomies are a highly effective procedure for focal extremity spasticity. Additional clinical series or trials would help establish the appropriate indications and durability and quantify the risks and benefits. The patient consented to treatment and publication.\n                  <\/jats:p>","DOI":"10.1093\/ons\/opab020","type":"journal-article","created":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T06:41:40Z","timestamp":1613284900000},"page":"E442-E443","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Highly Selective Partial Neurectomy for Lower-Extremity Spasticity: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"20","author":[{"given":"Hussam","family":"Abou-Al-Shaar","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-4701","authenticated-orcid":false,"given":"Mark A","family":"Mahan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,6]]},"reference":[{"issue":"1-4 Pt 2","key":"bib1-20251027","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1159\/000099884","article-title":"Microsurgical selective peripheral neurotomy in the treatment of spasticity in cerebral-palsy children","volume":"69","author":"Msaddi","year":"1997","journal-title":"Stereotact Funct Neurosurg"},{"issue":"5","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1227\/01.NEU.0000140840.59586.CF","article-title":"Spastic equinus foot: multicenter study of the long-term results of tibial neurotomy","volume":"55","author":"Buffenoir","year":"2004","journal-title":"Neurosurgery"},{"issue":"9","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1007\/s00381-007-0399-1","article-title":"Selective peripheral neurotomy (SPN) for spasticity in childhood","volume":"23","author":"Sindou","year":"2007","journal-title":"Childs Nerv Syst"},{"issue":"4","key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"247","DOI":"10.3340\/jkns.2010.47.4.247","article-title":"Long-term results of microsurgical selective tibial neurotomy for spastic foot: comparison of adult and child","volume":"47","author":"Kim","year":"2010","journal-title":"J Korean Neurosurg Soc"},{"issue":"4","key":"bib5-20251027","doi-asserted-by":"crossref","first-page":"277","DOI":"10.2340\/16501977-0786","article-title":"Effects of selective tibial nerve neurotomy as a treatment for adults presenting with spastic equinovarus foot: a systematic review","volume":"43","author":"Bollens","year":"2011","journal-title":"J Rehabil Med"},{"issue":"4","key":"bib6-20251027","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1159\/000345504","article-title":"Surgical outcomes of microsurgical selective peripheral neurotomy for intractable limb spasticity","volume":"91","author":"Sitthinamsuwan","year":"2013","journal-title":"Stereotact Funct Neurosurg"},{"issue":"7","key":"bib7-20251027","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.apmr.2010.04.010","article-title":"Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases","volume":"91","author":"Deltombe","year":"2010","journal-title":"Arch Phys Med Rehabil"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/20\/6\/E442\/37908032\/opab020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:03:17Z","timestamp":1786122197000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,13]]},"references-count":7,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab020","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,13]]},"assertion":[{"value":"2020-08-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-11","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}