Hyperselective neurectomy for the treatment of upper limb spasticity: a long-term follow-up.

Abstract

Hyperselective neurectomy is increasingly recognized as one of the major treatment strategies for spasticity of the upper limb. However, concern remains about postoperative recurrence of the spasticity. In a previous prospective study of 42 patients, we reported significant improvement in spasticity with minor recurrence but overall tone reduction at an average of 31 months post-surgery. In this follow-up study we reassessed a subpopulation of patients from the same cohort to evaluate the long-term efficacy of hyperselective neurectomy. At an average of 53 months post-surgery, the results of 39 patients showed a similar trend to the previous study with significant improvement in the modified Ashworth and Tardieu scale within a year, and this improvement remained stable at the final follow-up. There was also significant improvement in spontaneous posture (mean 75-40° elbow flexion), with no decline in the range of motion and strength of the operated muscles. Antagonist muscle groups and functional scores demonstrated a general trend towards improvement (House score from 2.2 to 3.4). This study highlights the sustained effectiveness of hyperselective neurectomy on upper limb spasticity more than 4 years after the procedure.Level of evidence: III.