gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Peroneal stimulation for the drop foot management after chronic stroke: Experiences in 25 patients

Meeting Abstract

  • V. Rohde - Abteilung für Neurochirurgie, Klinikum der Georg-August-Universität Göttingen
  • D. Wachter - Abteilung für Neurochirurgie, Klinikum der Georg-August-Universität Göttingen
  • J. Ernst - Abteilung für Klinische Neurophysiologie, Klinikum der Georg-August-Universität Göttingen
  • D. Liebetanz - Abteilung für Klinische Neurophysiologie, Klinikum der Georg-August-Universität Göttingen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.11.11

DOI: 10.3205/12dgnc265, URN: urn:nbn:de:0183-12dgnc2658

Published: June 4, 2012

© 2012 Rohde et al.
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Outline

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Objective: The drop foot substantially impairs the mobility of patients with chronic ischemic or hemorrhagic stroke. The use of an orthesis or external stimulator are the common therapeutic options which have the shortcomings of being cumbersome during activities of daily living and being painful (external stimulation). Recently a hybrid system with external sensor and antenna and internal stimulator for activation of the peroneal nerve (resulting in dorsiflexion) had been introduced, but no larger series exist. The aim of the study is to report our surgical and clinical experiences after 25 implantations.

Methods: Since 2008, the peroneal stimulator has been implanted in 25 patients with chronic stroke. Exclusion criteria were poor preoperative walking performance and contractions. In the last 23 implantations, an institutional standardized operative procedure was used. All patients underwent pre- and postoperative testing of gait velocity and walking distance. The postoperative investigations were performed on day 42 and 84. In addition five patients underwent gait analysis.

Results: In the first 2 patients, 1 nerve damage due to cuff movement into the branching area of the sensory branch and painful sensations were seen, initiating a standardization of the surgical procedure and the postoperative care. In the following 23 patients, sustained good implant function with significantly improved gait velocity (0.62 to 0.768 [day 42] and 0.772 m/sec [day 84]) and walking distance (210.75 m in 6 min to 260.25 [day 42] and 248.25 m [day 84]) was seen. In 2 patients, infection made implant removal after initial good function necessary. Gait analysis revealed an improved plantar flexion in the initial and a better push off in the terminal stand phase and a maximal dorsiflexion in the swing phase.

Conclusions: The peroneal stimulator is a promising therapeutic option for the management of drop foot in chronic stroke patients. The stimulator significantly improves the gait velocity and increases the walking distance. A standardized surgical protocol is useful to achieve optimal clinical results.