Hyperselective Peripheral Neurotomy for Spasticity: A Prospective Observational Study

Abstract

Objective : The aim of the study was to evaluate the effectiveness of hyperselective peripheral neurotomy in reducing spasticity and pain in patients with upper motor neuron disorders unresponsive to pharmacologic and reversible interventions.

 Materials and Methods :  A prospective observational study was conducted at a tertiary care center involving 21 adult patients with spasticity due to conditions such as stroke, traumatic brain injury, or spinal cord injury. Eligible participants had Modified Ashworth Scale (MAS) scores of 3 to 4 and were resistant to medical treatments like baclofen. Hyperselective neurotomy was performed under general anesthesia, targeting specific nerve branches for controlled reduction of muscle spasticity. Primary outcomes included MAS scores for spasticity reduction, motor power via Medical Research Council (MRC) grading, and pain assessment through visual analog scale (VAS) scores. Patients were assessed preoperatively and at 1, 3, and 6 months postsurgery.

 Results : All patients (100%) experienced a significant reduction in spasticity, with MAS scores reduced to 2 in all cases and 1 in 18 patients (p < 0.001) at 6 months. Pain relief was achieved in 62% of patients, with a postoperative VAS score of 0, and residual pain scores of 1 to 2 in the remaining patients. Minimal motor power improvement was observed in six patients, while the majority (71%) showed no change in strength. Complications included transient neuropathic pain in 29% of patients and one case of recurrent stroke.