{
  "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.\n\nMethods:: 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.\n\nResults:: 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.\n\nConclusions:: 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.\n\nLevel of Evidence:: Level III (retrospective comparative cohort study). See Instructions for Authors for a complete description of levels of evidence.",
  "abstract_shown": true,
  "affiliations": [
    "Olympia Hospital & Research Centre, Trichy, Tamil Nadu, India",
    "Trichy SRM Medical College, Trichy, Tamil Nadu, India"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "J. Terrence Jose Jerome",
      "orcid": "0000-0003-3321-9255"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Ganesan Surendran",
      "orcid": "0009-0008-8957-3695"
    },
    {
      "affs": [
        0
      ],
      "name": "Kuppusamy Thirumagal"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ag87tqsp6wvyt.bib",
  "cited_by": 0,
  "doi": "10.2106/jbjs.oa.26.00299",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13690457/",
  "id": "ag87tqsp6wvyt",
  "issns": [
    "2472-7245"
  ],
  "landing_url": "https://doi.org/10.2106/jbjs.oa.26.00299",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "0060"
    ],
    [
      "heading",
      "Observational Study"
    ],
    [
      "heading",
      "Scientific Articles"
    ],
    [
      "openalex",
      "2728|Botulinum Toxin and Related Neurological Disorders"
    ]
  ],
  "openalex": "W7223574737",
  "pdf_url": "https://europepmc.org/articles/PMC13690457?pdf=render",
  "pmcid": "PMC13690457",
  "pmid": "42924377",
  "published": "2026-10-27",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/ag87tqsp6wvyt.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:31Z",
      "native_id": "PMC13690457",
      "source": "pmc",
      "url": "https://doi.org/10.2106/jbjs.oa.26.00299"
    },
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42924377",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42924377"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Botulinum Toxin and Related Neurological Disorders",
      "subfield": "neurology"
    }
  ],
  "title": "Hyperselective Neurectomy for Upper-Limb Spasticity Under General Anesthesia or Wide-Awake Surgery",
  "title_text": "Hyperselective Neurectomy for Upper-Limb Spasticity Under General Anesthesia or Wide-Awake Surgery",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:33:30Z",
  "url": "https://research.draconitic.com/paper/ag87tqsp6wvyt",
  "venue": "JBJS Open Access",
  "versions": []
}