1048 - Cryoneurolysis for management of limb spasticity: A systematic review

Objective: Damage to upper motor neurons frequently results in spasticity, a condition that increases muscle tone and stiffness due to hyperexcitable stretch reflexes. Current treatment modalities include intrathecal treatments, oral antispasticity medicines, and botulinum toxin injections. However, these are sometimes limited by their invasive nature, adverse effects, and temporary effectiveness. A new technique for lowering spasticity is cryoneurolysis, a percutaneous nerve block that uses extremely low temperatures to induce pain relief and nerve regeneration. The effectiveness and safety of cryoneurolysis in treating limb spasticity across multiple conditions are assessed in this systematic review.

Design:

Methods: PRISMA 2020 guidelines were followed in conducting a systematic review. PubMed, Embase, Scopus, Cochrane Library, and Web of Science were reviewed in addition to a manual reference review. Randomized trials, retrospective studies, and case reports detailing the pre- and post-intervention results of cryoneurolysis in patients with limb spasticity were among the studies that qualified. The main outcomes included functional measurements and Modified Ashworth Scale (MAS) scores, which is a score system used to grade the intensity of spasticity.

Results:

Results: Six studies out of the 160 retrieved satisfied inclusion requirements. Across the case reports and small series studies, cryoneurolysis consistently showed improvements in gait metrics, functional mobility, range of motion, and MAS scores. Both upper and lower extremity spasticity improved across a range of etiologies, including traumatic brain injury, multiple sclerosis, and stroke, and the benefits typically lasted several months to over a year post-cryotherapy application. No significant adverse effects or major complications were reported.

Conclusions:

Conclusion: According to the preliminary data, cryoneurological is a minimally invasive, safe procedure that has been shown to reduce spasticity. Even though the outcomes of small studies seem promising, high quality prospective trials are required to show long-term effectiveness with current spasticity modalities/therapies.