Sonia E. Mejia, MD
Resident Physician
Texas Tech University Health Sciences Center
Lubbock, Texas, United States
Nicholas Tan, MD
Resident Physician
Texas Tech University Health Science Center, Division of Physical Medicine and Rehabilitation
Lubbock, Texas, United States
Bei Zhang, MD, MSc
Associate Professor
Texas Tech University Health Sciences Center
Lubbock, Texas, United States
Sheng Li, MD, PhD
Professor of PMR
University of Texas Health Science Center - Houston
Houston, Texas, United States
To compare the immediate efficacy of cryoneurolysis and phenol neurolysis in reducing spasticity in patients with brain (BI) or spinal cord injury(SCI).
Design:
Thirty-six patients (Mean age 37±17 years, time post-injury: 13±5 months) were prospectively assigned to receive either cryoneurolysis or phenol neurolysis to reduce spasticity due to chronic BI or SCI. 23 patients received phenol neurolysis (82 nerve blocks) while 13 underwent cryoneurolysis (39 nerve blocks). The injections were performed based on clinical necessity, targeting the muscle groups of bilateral shoulder, elbow, wrist, hip, and knee, and ankle joints. The outcome was retrospectively reviewed. Spasticity was measured using the Modified Ashworth Scale (MAS) before and immediately after each treatment session. MAS categories of 1, 1+, 2, 3 and 4 were converted to continuous scores of 1, 2, 3, 4 and 5, respectively, for statistical analysis. MAS reduction for each patient was derived from averaging the MAS scores across all joints.
Results:
Among all patients, 35 sustained BI (non-traumatic: 40%, traumatic: 25%, stroke: 35%) while 1 sustained SCI. There was a significant effect of intervention in spasticity reduction (cryoneurolysis: MAS pre-treatment 3.73 vs. post-treatment 1.09; phenol: MAS pre-treatment 3.83 vs. post-treatment 1.22; p< 0.05). However, there was no statistical significance in spasticity reduction between cryoneurolysis and phenol neurolysis interventions. Furthermore, no significant difference in average MAS reduction between phenol neurolysis and cryoneurolysis was found for muscle groups of individual joints, including shoulder adductors, elbow flexors, wrist flexors, finger flexors, and ankle plantar flexors.
Conclusions:
Both cryoneurolysis and phenol neurolysis demonstrated immediate spasmolytic benefits in patients with brain or spinal cord injury. However, there was no difference between cryoneurolysis and phenol neurolysis in reducing spasticity in muscle groups for various joints.
