Abstract Spasticity is a common manifestation of upper motor neuron syndrome due to central nervous system dysfunction and occurs in conditions such as traumatic brain injury, spinal cord injury, cerebral palsy and stroke. Excessive spasticity can interfere with posture, mobility and activities of daily living, requiring intervention. The first-line management typically includes physiotherapy, oral antispastic medications and botulinum toxin injections; however, surgical neurotomy remains a valuable option for localised spasticity unresponsive to conservative measures. We report the case of a 40-year-old male with post-traumatic paraplegia following a D12 compression fracture who developed equinus deformity due to poor adherence to home rehabilitation. Despite tendo-Achilles Z-plasty, he developed intractable right ankle clonus. He underwent selective tibial neurotomy combined with bilateral Baker’s procedure, resulting in the resolution of clonus and improved ankle mobility. Post-operative follow-up at 3 and 6 months demonstrated sustained functional improvement, enabling independent ambulation with walker support and no recurrence of clonus. Selective neurotomy should be considered in patients with refractory focal spasticity after failure of conservative therapies, providing durable functional improvement and enhancing the quality of life.
Debnath et al. (Mon,) studied this question.
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