Hyperselective Neurectomy for Upper-Limb Spasticity Under General Anesthesia or Wide-Awake Surgery
- 1Olympia Hospital & Research Centre, Trichy, Tamil Nadu, India
- 2Trichy SRM Medical College, Trichy, Tamil Nadu, India
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.
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BibTeX
@article{jerome2026hyperselective,
title = {{Hyperselective Neurectomy for Upper-Limb Spasticity Under General Anesthesia or Wide-Awake Surgery}},
author = {J. Terrence Jose Jerome and Ganesan Surendran and Kuppusamy Thirumagal},
journal = {JBJS Open Access},
year = {2026},
month = oct,
doi = {10.2106/jbjs.oa.26.00299},
url = {https://doi.org/10.2106/jbjs.oa.26.00299},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Hyperselective Neurectomy for Upper-Limb Spasticity Under General Anesthesia or Wide-Awake Surgery
AU - J. Terrence Jose Jerome
AU - Ganesan Surendran
AU - Kuppusamy Thirumagal
PY - 2026
DA - 2026/10/27
JO - JBJS Open Access
DO - 10.2106/jbjs.oa.26.00299
UR - https://doi.org/10.2106/jbjs.oa.26.00299
AB - 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.
SN - 2472-7245
ER -