32. Outcomes of Hyperselective Neurectomy for Pediatric Upper and Lower Extremity Spasticity

PURPOSE: Hyperselective neurectomy (HSN), the selective and partial sectioning of motor nerve fascicles near motor endplates, is a promising surgical treatment for extremity spasticity, but its application in children has not been well studied. We hypothesized that hyperselective neurectomy would yield significant improvements in spasticity and function with minimal complications in pediatric patients. METHODS: After IRB approval, we retrospectively reviewed the records of all pediatric patients with upper and lower extremity spasticity who underwent HSN by the senior author from 2021 to 2024. We collected demographic information, surgical details, complications, preoperative and postoperative Modified Ashworth scale (MAS), spontaneous posture, passive range-of-motion (pROM), and muscle strength (0-5). MAS scores were adjusted to a 6-point scale (0-5) for analysis. A paired t-test was used to compare preoperative and postoperative data for cases with complete datasets, with a p-value<0.05 indicating statistical significance. RESULTS: Twenty-five patients (56% male) underwent 59 upper and/or lower extremity HSN procedures at an average age of 11.5 years (range 6-23 years). Etiologies of spasticity included cerebral palsy (n=16, 64%), stroke (n=5, 20%), Leigh syndrome (n=2, 8%), intracranial hemorrhage (n=1, 4%) and traumatic brain injury (n=1, 4%). HSN was performed on 24 upper extremities (8 median, 8 musculocutaneous, 4 radial, 4 ulnar) and 35 lower extremities (21 obturator, 8 sciatic, 6 tibial). Most cases (81.4%) involved concurrent orthopedic procedures (tendon/muscle lengthening, tendon transfers, fusions). Average length of follow up was 6 months (range 1-18 months). MAS scores reduced significantly postoperatively (p<0.01) for both upper and lower extremity cases. Patients were also able to achieve more relaxed spontaneous postures and better pROM, while strength remained relatively stable. Complications included a bilateral lower extremity surgical site infection in one patient and hypertrophic scarring in another patient. There were no cases of recurrent spasticity requiring reoperation. CONCLUSION: Hyperselective neurectomy is a safe and effective treatment that improves pediatric extremity spasticity and enhances function without negatively affecting strength.