Surgical Results of Selective Median Neurotomy for Wrist and Finger Spasticity

ABSTRACT

OBJECTIVE: This study aimed to evaluate the surgical outcomes of selective median neurotomy (SMN) for spastic wrist and fingers. METHODS: We studied 22 patients with wrist and finger spasticity refractory to optimal oral medication and physical therapy. The authors evaluated spasticity of the wrist and finger muscles by comparing preoperative states with postoperative states using the modified Ashworth scale (MAS). We checked patients for changes in pain according to the visual analog scale (VAS) and degree of satisfaction based on the VAS. RESULTS: The preoperative mean MAS score was 3.27+/-0.46 (mean+/-SD), and mean MAS scores at 3, 6, and 12 months after surgery were 1.82+/-0.5, 1.73+/-0.7, and 1.77+/-0.81 (mean+/-SD), respectively. On the last follow-up visit, the mean MAS score measured 1.64+/-0.9 (mean+/-SD). Wrist and finger spasticity was significantly decreased at 3, 6, and 12 months after the operation (p<0.01). The preoperative mean pain VAS score was 5.85+/-1.07 (mean+/-SD), and the mean pain VAS score on the last follow-up visit after surgery was 2.28+/-1.8 (mean+/-SD). Compared with the preoperative mean pain VAS score, postoperative mean pain VAS score was decreased significantly (p<0.01). On the basis of a VAS ranging from 0 to 100, the mean degree of patient satisfaction was 64.09+/-15.93 (mean+/-SD, range 30-90). CONCLUSION: The authors propose SMN as a possible effective procedure in achieving useful, long-lasting tone and in gaining voluntary movements in spastic wrists and fingers with low morbidity rates.