Selective Neurectomy for Spasticity: A Single Center Experience
Ilyas Eli, MD; Hussam Aboualshaar, MBBS; Mark A. Mahan, MD
University of Utah, Salt Lake City, UT
Background: Spasticity is a devastating condition that can result from various etiologies including cerebral palsy, cerebrovascular accident, and spinal cord injury. Sedating antispastic medications like baclofen as well as focal therapies like botulinum toxin and phenol are the current primary therapies, where each therapy has associated challenges. Alternatively, focal spasticity can be addressed using selective denervation.
Methods: We retrospectively reviewed the medical charts of patients with upper and/or lower extremity spasticity that were operated on by the senior author between 2014-2017. Preoperative and postoperative Ashworth score, etiology, complications, and patients' satisfaction were recorded and analyzed. Ashworth scores were assessed independently by a physiatrist in all cases.
Results: Twenty-five total patients were included in our series. Seventeen males and eight females with an average age of 48. A total of 54 procedures for focal spasticity were performed on the patients; 68% of the selective neurectomies performed were for upper extremity spasticity, while 32% of the procedures were for lower extremity spasticity. On patients with follow up, the average preoperative Ashworth score was 3 and the average Ashworth score at final follow up was 1.35 (P < 0.001). Three patients required revision surgery, 2 due to incomplete relief. No perioperative complications were encountered in the series.
Conclusion: This is the first North American series of denervation procedures for spasticity. Selective neurectomy is a potential option for spastic patients that should be considered when conservative treatments fail or are inappropriate to the patient's condition. Thus far, denervation results suggest satisfactory short- and long-term outcomes with minimal morbidity and excellent patient satisfaction.
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