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

Archives of Rehabilitation Research and Clinical Translation, 2024 · DOI: https://doi.org/10.1016/j.arrct.2024.100374 · Published: January 1, 2024

Spinal Cord Injury Pain Management Rehabilitation

Simple Explanation

Spasticity, a common issue after spinal cord injury, can cause pain and limit movement. Cryoneurolysis, a drug-free procedure, is being explored to treat this. This report looks at how cryoneurolysis affected joint movement by reducing spasticity and pain in someone with quadriplegia (weakness in all four limbs) from a spinal cord injury. The patient experienced better movement and reduced muscle tone after the procedure, improving his ability to perform daily tasks. The benefits lasted up to 9 months.

Study Duration

9 Months

Participants

One 52-year-old male with C4 incomplete quadriplegia

Evidence Level

Level 4: Case Report

Key Findings

1
Cryoneurolysis led to immediate and sustained improvements in ROM in both upper and lower limbs.
2
The patient reported improvements in daily activities, such as independent showering and a decrease in muscle tone, after cryoneurolysis.
3
Repeat cryoneurolysis was effective in re-establishing the benefits after 9 months, when the effects of the initial procedure began to wane.

Research Summary

This case report investigates the effectiveness of cryoneurolysis for pain and spasticity in a patient with spinal cord injury, severe orthopedic deformity, and impaired hand function. Percutaneous cryoneurolysis resulted in several months of improved hip abduction and knee extension ROM, with retreatment at 9 months restoring gains. Wrist extension ROM and MAS scores were maintained. The study concludes that cryoneurolysis could be a long-lasting method for managing severe spasticity in SCI patients with minimal side effects, leading to increased independence and ease in daily activities.

Practical Implications

Improved Quality of Life

Cryoneurolysis offers a potential method for improving the quality of life and independence for patients with quadriplegia by managing pain and spasticity.

Alternative Treatment Option

Cryoneurolysis can be considered as an alternative or adjunct treatment for patients with SCI who have not responded well to traditional treatments like botulinum toxin injections or oral baclofen.

Reduced Risk of Complications

Cryoneurolysis may reduce the risks associated with hip arthroplasty in SCI patients, such as dislocation and component loosening, by alleviating spasticity-associated issues.

Study Limitations

1
The case study research design limits the generalizability of the findings.
2
Quadriplegia is a diverse condition with varying levels of severity and muscle involvement.
3
The results rely on individualized assessment and response to the diagnostic nerve block for each patient.

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