Thirty-two cases have been operated on by the Stoffel method. They have been under observation for periods of time up to six years. No definite relapse has occurred in any. The youngest patient was three years of age, the oldest twenty-seven. Fifteen cases were congenital in origin, eleven infantile, four traumatic, and two were due to spinal degeneration in adults.
No ill results followed operation in any one. Two cases required a second operation. The operations on the popliteal nerve have been almost uniformly successful in relieving the contracture of the tendo Achillis and in enabling the patient to stand and walk with the foot firmly on the floor, and in greatly improving the gait. The operations on the obturator nerve have in all instances corrected the adductor spasticity, which in most of them interfered greatly with walking. The results of the operations on the sciatic nerve for hamstring contracture have also been good. The operations on the median nerve have in all instances lessened the spasticity or corrected the deformity of the hand. In some instances the improvement in function of the hand was slight or negligible. In other instances it was very great. The hand is such a complex mechanism that it is more difficult to secure return of function when there is marked spasticity, and I feel that the results to be secured here are more uncertain than those to be secured in the lower extremity. The improvement is sometimes more brilliant but I do not feel so confident of it as I do of the results to be obtained in the lower extremity.
Where the patients have been of good mentality the results have always been very much better than where the patients have been backward or feeble-minded. I believe that we may always count on being able to cure any contractures that may be present whether in the upper or lower extremity, and the spasticity may be greatly relieved, but the amount of function, that is, of voluntary active motion of the member, which the patient will secure, depends upon the nature and the severity of the disease, upon the mentality of the patient, and upon the careful persistent after-treatment. In certain cases the deformity is relieved and the spasticity is improved but the patient is unable to establish voluntary control of the member. This, I take it, is possibly due to the organic nature of the disease. In such cases the cerebral control has been definitely and completely lost, either by injury to or disease of the cerebral centers or the cord. Even in such cases the patients are more or less improved by the moderation of the spasticity in the lower arc.
These methods of treatment have been applied to all spastic cases under my observation within the past six years. I believe that the Stoffel procedure is the best single operation which has thus far been proposed because it is applicable to a greater number of cases, the results obtained are more uniformly successful, the operation itself is in no way a severe one, and no ill results appear to follow it. Tendon lengthening is required in some cases and transplantation may be suitable in others; both of which may be combined with the Stoffel operation. It is not to be concluded that the Stoffel neurectomy is a panacea for spastic paralysis, nor that it is indicated in all cases. Judgment must be used in the selection of cases and in the time and application of the operation.