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1317 - Cryoneurolysis and Quadriplegia: A Case Report on Pain and Severe Spasticity Management

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Co-Author(s)

LS

Laura Schatz, BSc

Kinesiologist / Research Assistant
Vancouver Island Health Authority
Victoria, British Columbia, Canada
SH

Samuel Herzog, BSc

Research Assistant
Vancouver Island Health Authority
Victoria, British Columbia, Canada
MH

Mahdis Hashemi, MD

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

Presenting Author(s)

PW

Paul Winston, MD

Physiatrist
Vancouver Island Health Authority
Victoria, British Columbia, Canada

Case Diagnosis: C4 incomplete quadriplegia

Case Description: A 52-year-old male with C4 incomplete quadriplegia presents with severe right hip osteoarthritis, causing a severe hip flexion deformity with hip flexor spasms, as well as spasticity in the upper limbs. Previous attempts with exceeding maximum-dose botulinum toxin (BoNT) injections for the lower limb proved insufficient to improve range of motion. Percutaneous cryoneurolysis was performed to multiple nerves, contributing to spasticity in the upper and lower limbs. Immediately after each procedure, the patient experienced an increased range of motion in the upper and lower limb targeted regions. During the patient’s follow-up, he also reported improvements in performing daily activities, such as independent showering, no falls, and a significant decrease in muscle tone. Results were primarily maintained up to 9 months post-procedure, where cryoneurolysis was repeated for the lower limbs only. Upon repeat cryoneurolysis, results were re-established for the range of motion.

Discussions: Spasticity affects over 80% of spinal cord injury (SCI) patients, often impairing daily activities and commonly impacting lower extremity flexors. Treatments include antispasmodics like Baclofen and BoNT, with surgery for severe deformities. However, maximum BoNT doses are frequently insufficient and not always applicable to all muscle groups. Cryoneurolysis offers an alternative by using freezing temperatures to target and disrupt motor neuron conduction, providing both immediate and sustained relief from spasticity. This technique is minimally invasive, potentially suitable for patients who cannot undergo more invasive treatments, and may alleviate some associated risks, including those related to hip arthroplasty.

Conclusions: Cryoneurolysis is a non-surgical, percutaneous procedure which could be considered for pain and spasticity management in patients with quadriplegia. It can provide an option for improved quality of life and independence for patients.