Long-Term Outcome of Division of the C8 Nerve Root for Spasticity of the Hand in Cerebral Palsy

The authors report the long-term functional results and complications in 13 patients with cerebral palsy who underwent C8 nerve root division for treatment of hand spasticity.  The hands were assessed pre-operatively and at a mean of 8.6 years after surgery using the Lazareff grading system for muscular tension.  Two hands showed excellent improvement, 3 limbs showed good improvement, and 8 hands showed no improvement.  There were no recognized long-term complications.
 
Several treatments have been used to reduce muscle tone in children with spastic cerebral palsy, including physiotherapy, oral spasmolytic and anti-dystonic drugs, botulinum toxin injections, muscle lengthening, selective posterior rhizotomy, and division of the C8 nerve root.  Division of the C8 nerve root has been shown to result in short-term relief of spasticity (Gu et al, Chin J Hand Surg 1997; Hou et al, Chin J Microsurg 1999).  However, the findings from this study indicate that the long-term outcome of C8 nerve root division for the treatment of hand spasticity is generally poor.