A Systematic Review of Hyperselective Neurectomy for Management of the Spastic Upper Limb

Despite increasing clinical interest, there has yet to be a systematic evaluation of the literature regarding hyperselective neurectomy (HSN) for upper limb spasticity. In this study, we assess the results of HSN on spasticity reduction, muscle strength preservation, and range of motion (ROM). Nine studies were included from Ovid MEDLINE, Embase, and Scopus, detailing the outcomes of 253 HSNs targeting the shoulder, elbow, forearm (pronators), wrist, and digits. Hyperselective neurectomy demonstrated reductions in spastic tone while preserving or modestly improving strength and ROM in both agonist and antagonist muscle groups. Slight recurrence of spasticity was frequently reported among studies with longitudinal follow-up, but this did not reach statistical significance. Interpretation of results is constrained by heterogeneity in surgical technique, follow-up duration, patient characteristics, and outcome measures. Future studies should aim to standardize fascicle resection thresholds, report uniform outcome metrics, and extend follow-up duration to identify optimal surgical strategies, evaluate the risk of delayed recurrence, and identify patient subgroups most likely to benefit from HSN.