Surgery and Neuroablative Procedures in Spasticity
Condition: Upper Extermity Spasticity; Multidisciplinary Approach; Novel Algorithm; Diagnostic Nerve Block; Surgery; Percutaneous Neuroablative Procedures; Refractory Spasticity
MeSH terms: Muscle Spasticity
Study type: Observational [Patient Registry]

Summary: 
      For many patients with spasticity, traditional therapies have not achieved maximal outcomes.
      Due to common complaints such as pain, limb positioning and hygiene concerns, there has been
      an increase demand for other adjunctive therapies like surgeries and other interventions.
      This spasticity multidisciplinary clinic consisting of a physiatrist, plastic surgeon and
      anesthesiologist is performing a novel approach to refractory spasticity to triage and
      designed a treatment plan for them as routine medical care. This study will document the
      efficacy of this novel designed multidisciplinary approaches for intervention in complex
      spasticity patients, and will develop a decision-making algorithm in spasticity including
      both traditional treatment (i.e. botulinum toxin , bracing) and novel treatments(i.e.
      neurectomy , cryoneurotomy).
    

Detailed description: 
      Many patients continue to live with disabling spasticity that negatively affects their
      health, independence and quality of life. For these patients, traditional therapies such as
      bracing, medications, and botulinum toxin have not achieved maximal outcomes. Up to
      one-quarter of physicians have noted to be limited by the maximal dosage of botulinum toxin
      allowed in their country. Due to common complaints of pain, difficulty with limb positioning,
      and hygiene concerns there has been an increase in demand for novel adjunctive therapies,
      including surgery, to improve patient outcomes.

      The deisgned triage pathway is based on the diagnostic lidocaine nerve block (DNB), which is
      already using in Franco-European studies and has been accepted as academic abstract at the
      Canadian Association of Physical Medicine and Rehabilitation Annual Meeting in Gatineau
      Quebec in 2019. In this approach, patients are triaged for intervention based on their
      responses to DNB, which is applying local anesthesia to a selected nerve branch. Also the
      investigators of this study who have created Canada's first interdisciplinary spasticity
      clinic consisting of a physiatrist, plastic surgeon and anesthesiologist are working to bring
      the world-leading spasticity interventions to Canada and developing Canadian techniques. This
      includes cryoneurotomy and selective microfascicular neurectomy. Both of these techniques
      have been developed in this multidisciplinary clinic and in the past three years and have
      been published as journal articles, academic posters or presented at international
      congresses.This research is a pilot study to test the present current triage and treatment
      pathways. This study will evaluate the patients with upper limb spasticity who are going to
      have any of traditional treatments (i.e. bracing, botulinum toxin) or novel treatments (i.e.
      cryoneurotomy, tenotomy, neurotomy) as their standard medical cares. All these assessments
      are parts of their standard evaluations and the available data will be collected for this
      study. These data include their range of motions, spasticity grades, upper limb function,
      pain, satisfaction and injected botulinum toxin dosage. These data will be used to document
      the efficacy of this approach by comparing these measurements that are already done for their
      standard clinical care. Also, the final result will be helpful to create a Canadian algorithm
      to approach patients with refractory upper limb spasticity.
    

Intervention name(s): Surgery
Intervention type(s): Procedure
Intervention description(s): Orthopedic surgery (i.e. tenotomy, tendon transfer) or percutaneous neuroablative procedures (i.e. cryoneurotomy) which will be done for upper limb refractory spasticity after being triaged by DNB.
Other intervention name(s): Percutaneous neuroablation
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Any adult patient with upper limb spasticity who has been triaged to have surgery or
        neuroablative procedure after undergoing a successful DNB.