Neuro-orthopedics - Dr. Paolo Zerbinati at Gait and Motion Analysis Laboratory

Neuroorthopaedics is the branch of orthopaedics that deals with the treatment of patients who had implications at the level of the central nervous system, so we are talking about patients with outcomes of cerebral palsy in childhood, that is, premature babies without sufficient development of the central nervous system. They are children with problems of late acquisition of the normal stages of evolution, children who in some cases started walking around 2-3 years old, children who could have lost the ability to walk or could have had different motor disabilities depending on the degree of injury of the central nervous system. I deal with other diseases in the field of neuroorthopaedics like the ischemic events, commonly known as “stroke” that causes lesions at the central nervous system, and therefore with the consequent sadly known as case of “hemiparesis”. Patients with hemiparesis are patients that both at the level of the upper limb and at the level of the lower limb lose the normal activity of muscle contraction. In this cases we will face characteristic deformities, as the “clubfoot”, which is a foot deformity that affects the bottom and the interior side of the foot and this is why the patient has difficulty in walking and in just managing normal daily activities too. At the level of the upper limb patients with hemiparesis will have a deformity at the shoulder, elbow, hand and then with a subsequent loss of normal limb functions. Other pathologies in the field of neuro-orthopaedic interest are the outcomes of headl traumas, unfortunately these patients are usually very young and with consequences of road accidents, with cases of tetraparesis too, that is, an involvement of all four limbs. All neuromuscular diseases are part of neuroorthopaedics as well. I mean, those genetic diseases where we will face an alteration at the level of the nerve conduction that will consequently determine deformities at the foot and hand level. One of the most common diseases is Charcot Marie Tooth. Today the neuro orthopaedic surgeon makes use of significant diagnostic instruments that include the examination of the path, which means that the patient, both the small child with cerebral
palsy and the adult with stroke outcomes, is evaluated through the examination of the path according to its residual walking capacity, as well as analyzing the activity of the different muscles that are involved in the deformity. In addition we can understand which muscles are more active and which muscles have lost their activity and their ability to be recruited instead. Thanks to the examination of the path, the functional surgeon has a better idea about what type of surgery can be used and therefore, he brings the patient into the operating room and on the guidance of this examination performed before the surgery, he performs some surgeries. What about the surgeries? They concern stretches of tendons that have shrunk. They imply a tendon transference, that means transferring a tendon that performs normally, half or the entire tendon, in such a way as to correct the deformity using the tendon itself, as well as shortening the muscles more, that instead have stretched too much, and perform interventions on skeletal deformities, such as the foot, to try to correct the remaining deformities there. At the hospital where we use it, at Sol et Salus, we have at our disposal both a laboratory of analysis of the path and a specific neuromotor rehabilitation program that allows me as a surgeon to have the exact information on the type of surgery and after the surgery I have the opportunity to keep the patient hospitalized for a month to perform the essential rehabilitation for the recovery and the achievement of our goals. the surgeon must have precise objectives to suggest to the patient, and this is different from an orthopedic surgery, for example, in which we just put a prosthesis or heal a fracture. In the case of functional surgery, we deal with a neurological patient, a patient with alterations at the level of muscle activation where in many cases it is difficult to bring it back to normality. That’s why functional surgery must have specific objectives. We mainly work on the recovery of gait, the patient with an outcome of a brain disease and the consequent alteration of the mechanism of muscle contraction will have a deformity in the foot, a rigid knee and a difficulty in moving the joints normally. Functional surgery aims to correct deformities to allow a recovery of the path as much as possible without aids, as a commercial shoe, a lightweight stick and without the need of a series of principals, knee pads, orthosis that before the patient needed to use.
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Sei il migliore ti ringrazio sempre di ❤️ ❤❤❤❤❤hai fato miracoli con piede di Ade ti sarò riconoscente tutta la vita midico eccellente con humanita che pochi hanno. Grz doc Zerbinati.

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