Current status of functional lower extremity surgery in adult spastic patients.

Ten percent of upper motor neuron spastic patients are candidates for functional surgery. If the main cause of the disability is abnormal muscle tone and not sensation, balance, cognition, or perceptual problems, good results from tendon lengthening or transfers are to be expected. The preoperative work-up should consist of examination, trial orthoses, nerve blocks, and most importantly dynamic electromyography. Releases or neurectomies are generally done in nonfunctional patients. Phenol blocks are a temporizing procedure during the phase of neurologic recovery. The patients all tolerated the anesthesia well, and the surgical risks are the same as in other lower extremity procedures.