Alcohol Neurolysis of the Sciatic and Femoral Nerves to Improve Pressure Ulcer Healing

Abstract

We present our experience with a paraplegic man who suffered from chronic right trochanteric and ischial pressure ulcers that failed to heal despite surgical and conservative treatment. We report the successful treatment of knee and hip flexor spasticity with a femoral and sciatic alcohol neuroablation technique. It was not until the successful control of his lower extremity spasticity that the pressure ulcers showed signs of healing. Neuroablation nay be considered for spasticity control when more conservative approaches fail or are not feasible.

Chemodenervation for treatment of limb spasticity following spinal cord injury: a systematic review

“…Chemodenervation in spinal cord injury J Lui et al individuals with SCI have been reported in four level 4 pre-post studies [35][36][37][38] and six level 5 studies (5 case series/studies, [40][41][42][43][44] one retrospective chart review 39 ). Results from these studies are summarized in Table 3.…”

“…Ghai et al, 35 Yasar et al 39 and Uchikawa et al 37 used MAS as a primary outcome measure, otherwise selection of outcome measures was variable between studies. The three case studies [42][43][44] did not report formal outcome measures and instead provided qualitative descriptions.…”

“…Seven [35][36][37][38][39]41,43 of the 10 studies involved phenol injections ranging from 0.3 to 10 ml and 5 to 6% concentration. Alcohol concentration used in three case series/studies 40,42,44 ranged from 68 to 100%, with volumes between 7.5 and 10 ml. Uchikawa et al 37 injected subscapularis motor points and Koyama et al 41 injected motor points of the psoas muscle.…”

“…There is level 4 and 5 evidence from four pre-post studies, [35][36][37][38] one retrospective chart review 39 and four case series/studies 40,41,43,44 that chemodenervation with phenol/alcohol improves limb spasticity as measured by outcomes of body structure and function (for example, MAS, AS, pain visual analogue scale and range of motion). There is level 5 evidence from a retrospective chart review 39 that phenol neurolysis of obturator nerves improves buttock seat interface pressures, which would presumably decrease the risk of pressure ulcers, in individuals with hip adductor spasticity from SCI.…”

“…Nine studies investigated the use of BoNT, [26][27][28][29][30][31][32][33][34] and 10 studies investigated phenol/alcohol [35][36][37][38][39][40][41][42][43][44] for management of spasticity in SCI with chemodenervation. The literature search did not identify any randomized or non-RCTs looking at management of spasticity in a sample population with ⩾ 50% SCI participants, precluding the use of PEDro and Downs and Black Scale for quality assessment.…”