Obturator neurolysis using 65% alcohol for adductor muscle spasticity

Abstract

Spasticity is motor alteration characterized by muscle hypertonia and hyperreflexia. It is an important complication of spinal cord injury, traumatic brain injury, cerebral palsy, and multiple sclerosis. If uncorrected, fibrosis and eventually bony deformity lock the joint into a fixed contracture. Chemical neurolysis using various agents is one of the therapeutic possibilities to alleviate spasticity. We are, hereby, reporting 3 patients in whom 65% alcohol was used as neurolytic agent for the treatment of hip adductor spasticity, and the effect lasted for a variable period.

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

“…Duration of improvement lasted 6 months in the study by Takenaka et al, 43 3-4 months in Singler et al, 42 and 6 months in Ghai et al, 40 depending on the outcome measure. All other studies did not comment on the duration of improvement, although benefits were still present at 2 months in Gunduz et al 36 and 3 months in Ghai et al 35 Wassef et al 38 used two different techniques to target the obturator nerve (interadductor versus traditional technique) and found no differences between the two approaches.…”

“…Studies looking at outcome measurements of activity consistently found improvements. Ghai et al 35,40 and Wassef et al 38 reported improved hygiene score, which measured the ability of nursing staff to access the perineal area. Ghai et al 35 also reported an improved gait score after neurolysis as measured by the gait scale (0 = able to walk without difficulty, 3 = unable to walk) in three ambulatory participants, although whether these participants had SCI was not reported.…”

“…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.…”

“…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.…”

“…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.…”