Surgical interventions in adult upper limb spasticity management: a systematic review

Upper limb spasticity following upper motor neuron lesion is a key cause of long-term disability in adults, causing functional loss, pain, and reduced quality of life. Surgical management is an under-utilized intervention, and little work has been performed to collate and evaluate the evidence for these interventions. We undertake the first, PRISMA-compliant systematic review synthesizing the evidence for surgical management of spasticity in adults. Three databases were searched using pre-specified search strings over a 20-year window (September 2001-2021). Only primary research papers featuring an entirely adult sample were included. Case reports were excluded. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine Scale and the Methodological Index for Non-Randomized Studies. We identified 19 eligible studies, all of which were poor quality. Significant benefit of surgery was identified in 15 of the 16 studies conducting significance testing. Detailed analysis of the surgical procedures used was prevented by poor reporting. Studies reported low rates of serious postoperative complication, and relatively high rates of postoperative deformity recurrence. Studies' approaches to patient assessment and management varied significantly, reflecting a lack of standardization in this field. This review suggests that higher-quality, more standardized evidence is required to demonstrate the safety and efficacy of these surgical procedures. Future work should focus on improved reporting of surgical procedures and development of consensus assessment tools focusing on assessment of patient functionality and quality of life.