Crioneurolysis for the Management of Delayed Spinal Cord Injury Following Electrical Injury: A Case Report.
- 1Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, PRT.
- 2Physical Medicine and Rehabilitation, Unidade Local de Saúde do Médio Tejo, Leiria, PRT.
Abstract
Delayed spinal cord injury is a rare but clinically significant complication of high-voltage electrical trauma, and spasticity represents one of its most disabling long-term sequelae, with current pharmacological options offering only transient benefit. We report the case of a Caucasian man who sustained a high-voltage electrical injury at 43 years of age in 2001, with an entry point on the left hand and an exit point on the right foot. One year later, he developed progressive spastic paraparesis, and evaluation in 2021 revealed an incomplete paraplegia (American Spinal Injury Association Impairment Scale (AIS) grade D; neurological level, L1) with myelomalacia at D5-D7. Inpatient rehabilitation with botulinum toxin injections initially improved gait symmetry, but muscle tone progressively increased over the following two years despite escalating doses. In 2024, refractory hip adductor spasticity and pain persisted despite optimized pharmacological and physical therapy. An ultrasound-guided diagnostic bilateral block of the anterior and posterior obturator nerve branches produced marked improvement in spasticity, gait, and pain, and the patient subsequently underwent cryoneurolysis of the obturator nerve branches using a freeze-thaw-freeze protocol. At follow-up, he showed improved passive range of motion, reduced adductor tone, and improved gait capacity with a walker, allowing botulinum toxin to be redistributed to other muscle groups at lower adductor-targeted doses. Cryoneurolysis, which induces a reversible axonotmesis, offers a longer-lasting alternative to chemodenervation for refractory focal spasticity, particularly when a diagnostic nerve block confirms a clear anatomical target. This case supports its role as a valuable adjunctive option for spasticity following delayed post-electrical spinal cord injury.
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BibTeX
@article{andradesousa2026crioneurolysis,
title = {{Crioneurolysis for the Management of Delayed Spinal Cord Injury Following Electrical Injury: A Case Report.}},
author = {Maria João Andrade-Sousa and Inês P Morais and João Constantino and Paulo Margalho and Simão Serrano},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117343},
url = {https://europepmc.org/article/MED/42968889},
note = {CC BY},
}
RIS
TY - JOUR
TI - Crioneurolysis for the Management of Delayed Spinal Cord Injury Following Electrical Injury: A Case Report.
AU - Maria João Andrade-Sousa
AU - Inês P Morais
AU - João Constantino
AU - Paulo Margalho
AU - Simão Serrano
PY - 2026
DA - 2026/10/02
JO - Cureus
DO - 10.7759/cureus.117343
UR - https://europepmc.org/article/MED/42968889
AB - Delayed spinal cord injury is a rare but clinically significant complication of high-voltage electrical trauma, and spasticity represents one of its most disabling long-term sequelae, with current pharmacological options offering only transient benefit. We report the case of a Caucasian man who sustained a high-voltage electrical injury at 43 years of age in 2001, with an entry point on the left hand and an exit point on the right foot. One year later, he developed progressive spastic paraparesis, and evaluation in 2021 revealed an incomplete paraplegia (American Spinal Injury Association Impairment Scale (AIS) grade D; neurological level, L1) with myelomalacia at D5-D7. Inpatient rehabilitation with botulinum toxin injections initially improved gait symmetry, but muscle tone progressively increased over the following two years despite escalating doses. In 2024, refractory hip adductor spasticity and pain persisted despite optimized pharmacological and physical therapy. An ultrasound-guided diagnostic bilateral block of the anterior and posterior obturator nerve branches produced marked improvement in spasticity, gait, and pain, and the patient subsequently underwent cryoneurolysis of the obturator nerve branches using a freeze-thaw-freeze protocol. At follow-up, he showed improved passive range of motion, reduced adductor tone, and improved gait capacity with a walker, allowing botulinum toxin to be redistributed to other muscle groups at lower adductor-targeted doses. Cryoneurolysis, which induces a reversible axonotmesis, offers a longer-lasting alternative to chemodenervation for refractory focal spasticity, particularly when a diagnostic nerve block confirms a clear anatomical target. This case supports its role as a valuable adjunctive option for spasticity following delayed post-electrical spinal cord injury.
SN - 2168-8184
ER -