T1 rhizotomy for post-stroke hand flexion spasticity: a preliminary report of 15 cases

Stroke is the leading cause of central upper limb spastic paralysis, with hand flexion spasticity being the most common and functionally debilitating manifestation. Various surgical approaches have been explored, yet optimal management remains challenging. This study proposes T1 rhizotomy as a novel surgical intervention for post-stroke hand flexion spasticity.

Fifteen consecutive patients with unilateral post-stroke hand flexion spasticity underwent T1 rhizotomy between November 2023 and December 2024. Under general anesthesia, the T1 nerve root was exposed via a supraclavicular approach, transected distally, and a 1 cm proximal segment was resected. Safety and complications were recorded. Patients were followed for at least one year. Spasticity was assessed using the Modified Ashworth Scale (MAS) and hand function using the modified House Functional Classification (HFC). Functional and ADL outcomes were assessed using the QuickDASH questionnaire and the Barthel Index.

All procedures were completed successfully without intraoperative complications or major adverse events. Transient postoperative numbness or mild forearm pain occurred in some patients and resolved within three months. At final follow-up, mean MAS score decreased from 3.07 ± 0.59 preoperatively to 1.20 ± 0.86, and mean HFC grade improved from 1.07 ± 0.26 to 2.73 ± 0.88. Wilcoxon signed-rank tests confirmed significant improvements (MAS: Z = -3.42, p < 0.001, r = 0.88; HFC: Z =  + 3.35, p < 0.001, r = 0.87). Two patients with preoperative MAS grade 4 rebounded to grade 3, while the remaining 13 maintained a 2-grade reduction. The mean QuickDASH score improved from 52.47 ± 6.01 to 34.00 ± 7.97 (p < 0.001, d = 2.56), and the mean Barthel Index increased from 66.73 ± 4.30 to 83.00 ± 5.26 (p < 0.001, d = 3.42). All improvements were statistically significant and showed large effect sizes.

T1 rhizotomy appears safe and effective for post-stroke hand flexion spasticity, significantly reducing spasticity and improving hand function. Further studies with extended follow-up are warranted.