Hyperselective Neurectomy in the Treatment of the Spastic Upper Limb

Cerebral palsy is a general term that includes all the sequelae of infantile encephalopathies occurring during the perinatal period or during infancy, responsible for a permanent disorder of the development of movement and posture, resulting in a diminution of function. It manifests progressively during growth, but once established, follows a non-progressive course. Surgery is one element of the rehabilitative care, which includes primarily physiotherapy and splinting, occupational therapy, and pharmacological treatment as needed. Different surgical techniques are utilized to address the different components of the deformities, namely spasticity itself, muscle contracture, joint contractures, and paralysis. Partial neurectomy of motor nerves has been shown to reduce spasticity in the target muscles. It is effective only on the spastic component of the deformity, underlining the need for a preliminary thorough clinical examination. Hyperselective neurectomy, which consists in following each motor ramus until its entry point into the target muscle, aims at improving selectivity, widespread partial denervation, and durability of the results.