400 Section - Nerve and tendon-based procedures for the management of limb spasticity: the experience from a single-centre multidisciplinary clinic

Despite surgical advancements, very little prospective clinical data exists regarding short and long-term outcomes following neurectomy and tendon procedures for spasticity management, and the role of diagnostic nerve blocks in clinical decision making. The purpose of this research is to determine the impact of neurectomy and tendon-based procedures on clinical outcomes.

Design:

We have created a multidisciplinary clinic where patients are evaluated for consideration of surgical interventions for spasticity management.  This study involves a prospective cohort study of individuals who attend this clinic and receive either tendon-based procedures (e.g. tendon lengthening and transfers) or a peripheral neurectomy, to manage their limb spasticity.

Results:

To date, three patients (ages 29-71) have provided consent to participate in this research study.  Sixty-six percent (n=2) had an ischemic stroke. None of the participants had functional use of their spastic limb prior to the surgical intervention. All the participants had surgical interventions involving an upper limb. Sixty-six percent (n=2) of the participants had both a neurectomy and a tendon lengthening procedure. All participants received diagnostic nerve blocks using ultrasound and EMG guidance prior to neurectomy. The positive results of these nerve blocks correlate with the positive outcomes post-operatively. Patients identified goals (e.g. hand hygiene) and their level of satisfaction with each goal (1=not satisfied and 10=very satisfied) pre and post-operatively. Satisfaction improved post-operatively for each goal across all participants. There were also notable improvements in degree of range of motion and in level of spasticity (Modified Tardieu and Ashworth scales) following surgical intervention.

Conclusion:

The preliminary results from this study highlight the positive impact that surgical intervention can have on spasticity management, and the role of diagnostic nerve blocks for informing surgical decision making. Over the next ten years, we will recruit more participants to better understand those candidates who can benefit from these surgical interventions.