Hyperselective neurectomy for the treatment of upper limb spasticity: a long-term follow-up
Sze Ryn Chung, Paolo Panciera, Camillo Fulchignoni, Caroline Leclercq
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