Objective To evaluate the efficacy of highly selective partial neurectomy (HSPN) for upper limb spastic hemiplegia. Methods A retrospective analysis was conducted on 29 patients with upper limb spastic hemiplegia who underwent HSPN, with a follow-up period of 6 months. The muscle tone, muscle strength, pain condition, and activities of daily living of the patients at different time points before and after the surgery were compared. Results The muscle tone scores showed that the elbow flexor tone at 1 week (1.48±0.51) and 6 months (2.21±0.73) after surgery were lower than preoperative levels (3.93±0.80), and the difference was statistically significant (P＜0.05). The muscle tone of the flexor wrist muscles was also lower at 1 week (1.41±0.50) and 6 months (1.69±0.81) after surgery than preoperative levels (4.13±0.71) , and the difference was statistically significant (P＜0.05). The wrist flexor tone at 6 months increased compared to 1 week after surgery, but remained significantly lower than preoperative levels. Muscle strength scores indicated that elbow flexor strength at 1 week postoperatively (3.14±0.35) decreased compared to preoperative levels (3.55±0.51), and increased at 6 months postoperatively (3.34±0.48), but the differences were not statistically significant. Wrist flexor strength at 1 week postoperatively (2.41±0.57) was significantly lower than preoperative levels (3.28±0.80) (P＜0.05), and increased at 6 months postoperatively (2.97±0.73) compared to 1 week (P＜0.05). Barthel Index scores at 6 months (84.86±19.41) were significantly higher than both preoperative (75.86±20.58) and 1 week postoperative values (77.86±19.62). Among 8 patients with preoperative pain, pain was gradually alleviated at 1 week and 6 months after surgery, and 7 patients developed postoperative pain, but the pain was relieved at 6 months after surgery. Conclusions HSPN can reduce the muscle tone of patients with spastic hemiplegia while preserving the voluntary motor function, improving the activities of daily living and relieving preoperative pain, and it is an effective surgical treatment method.
Key words
hemiplegia /
spasm /
neurectomy /
muscle tone
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Dobkin B H. Strategies for stroke rehabilitation[J]. Lancet Neurol, 2004, 3(9): 528-536.
[2] Marque P, Gasq D, Castel L E, et al. Post-stroke hemiplegia rehabilitation: evolution of the concepts[J]. Ann Phys Rehabil Med, 2014, 57(8): 520-529.
[3] Schaechter J D. Motor rehabilitation and brain plasticity after hemiparetic stroke[J]. Prog Neurobiol, 2004, 73(1): 61-72.
[4] Lee J H, Yang S N. Effectiveness of extracorporeal shock wave therapy after botulinum toxin injection for post-stroke upper extremity spasticity: a randomized controlled study[J]. Toxins, 2024, 16(4):197-210.
[5] Hall B J, Gillespie C S, Sneade C, et al. Patient selection in selective dorsal rhizotomy (SDR)[J]. Adv Tech Stand Neurosurg, 2025, 51:225-237.
[6] Apolo-Arenas M D, Jerônimo A F, Caña-Pino A, et al. Standardized outcomes measures in physical therapy practice for treatment and rehabilitation of cerebral palsy: a systematic review[J]. J Pers Med, 2021, 11(7):604.
[7] Langerak N G, Vaughan C L, Fieggen A G, et al. A prospective gait follow-up study 30 years after selective dorsal rhizotomy[J]. J Neurosurg Pediatr, 2025:1-10.
[8] Angulo-Parker F J, Adkinson J M. Common etiologies of upper extremity spasticity[J]. Hand Clinics, 2018, 34(4):437-443.
[9] Gohritz A, Fridén J. Management of spinal cord injury-induced upper extremity spasticity[J]. Hand Clinics, 2018, 34(4): 555-565.
[10] Petuchowksi J, Kieras K, Stein K. Rehabilitation strategies following surgical treatment of upper extremity spasticity[J]. Hand Clinics, 2018, 34(4): 567-582.
[11] Leclercq C. Selective neurectomy for the spastic upper extremity[J]. Hand Clinics, 2018, 34(4): 537-545.
[12] Mahan M A, Eli I, Hamrick F, et al. Highly selective partial neurectomies for spasticity: a single-center experience[J]. Neurosurgery, 2021, 89(5): 827-835.
[13] Abou-Al-Shaar H, Mahan M A. Highly selective partial neurectomy for lower-extremity spasticity: 2-dimensional operative video[J]. Oper Neurosurg, 2021, 20(6): E442-E443.
[14] Emamhadi M, Alijani B, Haghani D M, et al. Hyper-selective neurectomy for knee flexion spasticity: anatomic bases and surgical technique[J]. Surg Radiol Anat, 2023, 45(2): 201-205.
[15] Fouad W. Management of spastic hand by selective peripheral neurotomies[J]. Alex J Med, 2011, 47(3): 201-208.
[16] Kwak K W, Kim M S, Chang C H, et al. Surgical results of selective median neurotomy for wrist and finger spasticity[J]. J Korean Neurosurg Soc, 2011, 50(2):95-107.
[17] Maarrawi J, Mertens P, Luaute J, et al. Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients[J]. J Neurosurg, 2006, 104(2):215-225.
[18] Leclercq C, Perruisseau-Carrier A, Gras M, et al. Hyperselective neurectomy for the treatment of upper limb spasticity in adults and children: a prospective study[J]. J Hand Surg Eur Vol, 2021, 46(7):708-716.
[19] Sitthinamsuwan B, Chanvanitkulchai K, Phonwijit L, et al. Surgical outcomes of microsurgical selective peripheral neurotomy for intractable limb spasticity[J]. Stereotact Funct Neurosurg, 2013, 91(4):248-257.
[20] Msaddi A K, Mazroue A R, Shahwan S, et al. Microsurgical selective peripheral neurotomy in the treatment of spasticity in cerebral-palsy children[J]. Stereotact Funct Neurosurg, 1997, 69(4):251-258.
[21] Liu H, Fan L, Li J, et al. Combined selective peripheral neurotomy in the treatment of spastic lower limbs of spinal cord injury patients[J]. Acta Neurochir, 2022, 164(8):2263-2269.
[22] Mahan M A, Eli I, Hamrick F, et al. Highly selective partial neurectomies for spasticity: a single-center experience[J]. Neurosurgery, 2021, 89(5): 827-835.
[23] Oda K, Morishita T, Yatsugi A, et al. Pain relief following selective tibial neurotomy for spastic equinus foot secondary to stroke and traumatic brain injury[J]. World Neurosurg, 2022, 166:e583-e589.
PDF(970 KB)
