1308 - Cryoneurolysis for severe spasticity and contracture in the lower extremities in quadriplegia

Case Diagnosis: C4 incomplete quadriplegia, right hip osteoarthritis

Case Description: A 52 year old man with C4 incomplete quadriplegia presents with severe end stage osteoarthritis of the right hip, as well as spasticity and contracture in the lower extremities with hip flexion spasms. The patient had previously received repeat botulinum toxin injections at maximum doses to the lower extremity to insufficient effect. Percutaneous cryoneurolysis was performed on the nerve supply to the bilateral rectus femoris, Right rectus intermedialis, and right psoas at the hip, as well as to the bilateral anterior and posterior divisions of the obturator nerve. After the procedure, the patient experienced improvements in inter-knee distance of 14 cm, hip abduction of 15° bilaterally, and increases of 50° and 80° for right and left knee extension respectively. On 6-week follow-up, the patient reported improvements in performing daily activities, such as independent showering and no falls. The examining physician noted a significant decrease in clonus and muscle tone.

Discussions: Spasticity, characterized as a velocity-dependent increase in muscle tone, is present in over 80% of patients who have experienced a spinal cord injury. Spasticity is often a cause of worsening disability for these patients, commonly causing intense and painful muscle spasms, as well as leading to joint subluxations and contracture.

Conclusions: Cryoneurolysis is a non-surgical, percutaneous procedure which could be considered for the management of pain and spasticity in patients with quadriplegia. It can provide an option for improved quality of life and independence for patients who are not eligible for major surgery.