Hyperselective Neurectomy for Upper-Limb Spasticity: Clinical Outcomes From a Systematic Review

Area of Science:

• Neurosurgery
• Rehabilitation Medicine
• Neurology

Background:

• Upper-limb spasticity is a common and disabling consequence of neurological conditions like stroke, traumatic brain injury, cerebral palsy, multiple sclerosis, and spinal cord injury.
• Spasticity significantly limits functional independence, activities of daily living, and the ability of caregivers to provide assistance.

Purpose of the Study:

• To systematically review the existing literature on Hyperselective Neurectomy (HSN) for managing upper-limb spasticity.
• To evaluate the efficacy, durability, safety, and functional outcomes associated with HSN.

Main Methods:

• A systematic review was conducted following PRISMA 2020 guidelines.
• Ten studies involving 260 adult patients were analyzed.
• Data on spasticity reduction (Modified Ashworth Scale), functional improvements, complications, and recurrence rates were extracted and synthesized.

Main Results:

• HSN demonstrated a significant reduction in spasticity, averaging 1.64 points on the Modified Ashworth Scale (95% CI, 1.36-1.92).
• These benefits were durable, lasting up to 4-5 years, and were associated with improved function, range of motion, and easier patient care.
• Complications were rare and transient, with no reported permanent weakness in treated muscles. Recurrence was uncommon and manageable.

Conclusions:

• Hyperselective Neurectomy (HSN) is a safe and effective treatment for reducing upper-limb spasticity, leading to meaningful functional gains.
• The procedure offers durable tone reduction and improves quality of life for patients with various neurological conditions.
• Future research should focus on optimizing patient selection, utilizing advanced spasticity assessment tools, and comparing different anesthesia techniques, including Wide-Awake Local Anesthesia No Tourniquet (WALANT).