Work

Hyperselective Neurectomy for Upper-Limb Spasticity Under General Anesthesia or Wide-Awake Surgery

Year: 2026

Type: article

Abstract: Background: Hyperselective neurectomy (HSN) reduces focal upper-limb spasticity while preserving voluntary function. Wide-awake surgery allows intraoperative assessment of tone and movement, but comparative evidence is limited. Methods: We retrospectively studied 44 patients undergoing upper-limb HSN under general anesthesia (general anesthesia [GA]; n = 23) or wide-awake local anesthesia without a tourniquet (n = 21). Allocation was nonrandom, and wide-awake surgery was limited to patients able to cooperate with intraoperative testing. Mean follow-up was 23 months after GA and 24 months after wide-awake surgery. The patient was the primary unit of inference; nonindependent joint-level outcomes were summarized descriptively. Results: All wide-awake procedures were completed without conversion to GA (0%; exact 95% confidence interval [CI], 0%-16.1%). Intraoperative assessment prompted modification of the neurectomy plan in 5 patients (23.8%; 95% CI, 8.2%-47.2%). Mean House classification improved from 2.0 (SD, 1.0) to 3.8 (SD, 0.9) after GA and from 2.1 (SD, 0.9) to 4.4 (SD, 0.8) after wide-awake surgery; final patient-level distributions differed on rank-based comparison (p = 0.02). Both cohorts showed reduced spasticity and improved motion. Final elbow, forearm, and wrist active arcs were numerically greater after wide-awake surgery, whereas thumb arcs were similar. No major complications or reoperations occurred. Conclusions: Wide-awake HSN was feasible in selected cooperative patients and enabled intraoperative modification of the surgical plan. Although some outcomes numerically favored wide-awake surgery, the small, nonrandomized cohorts, selective eligibility, temporal and learning-curve effects, adjunct procedures, and clustered observations preclude causal or superiority conclusions. Level of Evidence: Level III (retrospective comparative cohort study). See Instructions for Authors for a complete description of levels of evidence.

Source: JBJS Open Access

DOI: 10.2106/jbjs.oa.26.00299

Authors: J. Terrence Jose Jerome, Ganesan Surendran, Kuppusamy Thirumagal

Institution: Trichy SRM Medical College Hospital and Research Centre

Language: English

Topic: Botulinum Toxin and Related Neurological Disorders

Subfield: Clinical Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,250