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428 - Electrophysiological Changes after Tibial Nerve Cryoneurolysis for the Spastic Equinovarus Foot

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

MH

Mahdis Hashemi, MD

Research Coordinator
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Co-Author(s)

Romain David, MD

Physiatrist
Poitiers University Hospita
Poitiers, Aquitaine, France
FM

Fraser A. MacRae, BSc

Research Assistant
Western University
london, Ontario, Canada
Ève Boissonnault, MD, FRCPC (she/her/hers)

Clinical Assistant Professor
University of Montreal
Montreal, Quebec, Canada
DV

Daniel Vincent, MD,FRCPC

MD
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Corresponding Author(s)

Paul J. Winston, MD,FRCPC

Associate Professor
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Objectives: Spastic equinovarus foot (SEF) is a common sequela of neurological disorders and can present a serious burden to patients’ quality of life, resulting in pain, decreased function, and reduced mobility. Cryoneurolysis is a novel intervention for spasticity involving the application of extreme cold to a nerve to induce the breakdown of the axon, relieving spasticity. The aim of this study is to evaluate the effect of cryoneurolysis on spasticity and electrophysiological parameters in SEF.

Design:

Patients scheduled to undergo cryoneurolysis for their spastic equinovarus foot were recruited prospectively and followed longitudinally for one year post treatment. The main outcomes of interest were the H-reflex amplitude, latency, and the ratio of the H-reflex to M-wave amplitudes. Clinical outcomes including spasticity severity and maximum passive range of motion for ankle dorsiflexion with knee extended and knee flexed were assessed.

Results: H-reflex amplitude was significantly decreased at all follow ups up to one year post treatment (mean=4.7, SD=3.9 vs mean=2.7, SD=2.81; p=0.01). H/M ratio was significantly decreased at 240- and 360-days post treatment (mean=0.5, SD=0.33 vs mean= 0.33, SD=0.28, p=0.009 and mean=0.29, SD=0.20, p=0.0002). The baseline measures of ankle dorsiflexion spasticity, using Modified Ashworth Scale, with knee extended and knee flexed were 3.4, SD=0.71 and 3.25, SD= 0.8, respectively. The MAS revealed significant improvement at all follow ups up to one year (mean=2.3, SD=0.81, p=0.00 and mean=2.1, SD=0.82, p=0.00). Maximum ankle dorsiflexion passive range of motion with knee extended significantly increased at 1,3,9 and 12-month follow ups and with knee flexed at 1, 9 and 12-month post treatment follow ups.

Conclusions:

Cryoneurolysis elicited peripheral electrophysiological changes and clinical improvements indicative of decreased spasticity severity lasting for one year post treatment. Cryoneurolysis merits further investigation as a potential long-lasting, minimally invasive, drug free intervention for the spastic equinovarus foot.