title: Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients.
abstract: OBJECTIVE
  To manage refractory upper-limb spasticity, selective peripheral neurotomy (SPN) is proposed when the spastic muscles to be treated are under the control of a single or a few peripheral nerves. The aim of this study was to assess prospectively the long-term effects of SPN.
  
  
  METHODS
  Thirty-one patients with disabling upper-limb spasticity were selected by a multidisciplinary team using clinical, analytical, and functional scales as well as nerve block tests for assessment. Sixty-four SPNs were performed at the level of the musculocutaneous (15 SPNs), the median (25 SPNs), and the ulnar (24 SPNs) nerves. Results of a long-term follow up (mean 4.5 years) showed statistically significant improvement on 1) analytical assessment (p < 0.01): resting position, active amplitude, and motor strength; 2) Ashworth Scale scoring (p < 0.01); 3) hand function assessment (p < 0.01); and 4) rating of daily activities. Four patients with severe painful spasticity experienced complete pain relief after surgery. On the basis of a Visual Analog Scale ranging from 0 to 100, the mean degree of patient satisfaction was 61.5. Complications occurred in five patients (15%): two postoperative hematomas, one (temporary) hypesthesia, and one transient paresia of the wrist and finger flexors.
  
  
  CONCLUSIONS
  Selective peripheral neurotomy leads to long-term satisfactory improvement in function and/or comfort with a low morbidity rate in appropriately selected patients suffering from severe harmful spasticity of the upper limb that has been refractory to conservative therapy. Patients must be selected after complete assessment by a multidisciplinary team.
authors.affiliation: Department of Functional Neurosurgery, Hôpital Neurologique, Claude-Bernard University-Lyon I, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Maarrawi
authors.forename: Patrick
authors.initials: P
authors.lastname: Mertens
authors.forename: Jacques
authors.initials: J
authors.lastname: Luaute
authors.forename: Christophe
authors.initials: C
authors.lastname: Vial
authors.forename: Nicole
authors.initials: N
authors.lastname: Chardonnet
authors.forename: Maryse
authors.initials: M
authors.lastname: Cosson
authors.forename: Marc
authors.initials: M
authors.lastname: Sindou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000601:surgery*; D009407:Nerve Block; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010146:Pain; D010291:Paresis / Q000209:etiology; D017060:Patient Satisfaction; D010525:Peripheral Nerves / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome