Obturator Neurectomy for the Treatment of Adductor Spasticity: A Novel Technique and Case Series

Background The management of adductor spasticity and long-term sequelae for cerebral palsy (CP) patients is complex. Hip displacement is a common consequence of CP, and obturator neurectomy (ON) is a potentially underutilized procedure to address the underlying adductor spasticity. The aim of this study is to describe the operational technique of ON and highlight the potential efficacy of ON in reducing spasticity, as well as pain, hip, and functional outcomes in these patients. Methods A total of eight patients from Texas Children's Hospital who underwent ON between 2008 and 2023 were included in this case series. Results ON led to a qualitative decrease in adductor spasticity and had high patient-reported satisfaction. The average length of stay was 1.6 days (range: 1-4 days). Hip outcomes improved in all patients, evidenced by increased hip range of motion, improved mobility/gait, and decreased migration index (MI) in one patient. Conclusions ON is an efficient procedure that has the potential to reduce adductor tone and improve hip outcomes. The operative technique described and the reported patient satisfaction support the integration of ON into the paradigm of adductor spasticity management. Further prospective studies, however, are needed to objectively measure tone and hip outcomes in these patients.