Jay Karri, Manuel F. Mas, Gerard E. Francisco, Sheng Li
Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston McGovern Medical School, USA
DOI: 10.2340/16501977-2239

Objective: To present practice patterns for phenol neurolysis procedures conducted for spasticity management.
Design: A retrospective review of 185 persons with spasticity who underwent phenol neurolysis procedures (n = 293) at an academic rehabilitation hospital and clinic. Patient demographics, concomitant spasticity treatments, and procedure relevant information were collected.
Results: The cohort included 71. 9% males and 61. 6% inpatient procedures. Neurological diagnoses included stroke (41. 0%), traumatic brain injury (28. 6%) and spinal cord injury (24. 3%). Musculoskeletal diagnoses included spastic hemiplegia or paresis (51. 3%), tetraplegia (38. 4) and paraplegia (9. 2%). At the time of phenol neurolysis, most patients (77. 5%) received concomitant pharmacological treatments for spasticity. Injection guidance modalities included electrical stimulation and ultrasound (69. 3%) or ultrasound only (27. 3%). A mean of 3. 48 ml of phenol were injected per nerve and 10. 95 ml of phenol were used per procedure. Most commonly injected nerves included the obturator nerve (35. 8%) and sciatic branches to the hamstrings and adductor magnus (27. 0%). Post-phenol neurolysis assessment was recorded in 54. 9% of encounters, in which 84. 5% reported subjective benefit. Post-procedure adverse events included pain (4. 0%), swelling and inflammation (2. 7%), dysaesthesia (0. 7%) and hypotension (0. 7%).
Conclusion: Phenol neurolysis is currently used to reduce spasticity for various functional goals, including preventing contractures and improving gait. Depending on the pattern of spasticity displayed, numerous peripheral nerves in the upper and lower extremities can be targeted for treatment with phenol neurolysis. Further research into its role in spasticity management, including studies exploring its cost-effectiveness and pharmacological and side-effects compared with other treatment options are needed.

Phenol neurolysis is currently used, but not as common as compared to botulinum toxin injections, for spasticity management. In this study, we reviewed 293 phenol neurolysis procedures performed in 185 patients with different impairments (stroke, traumatic brain injury, and spinal cord injury) over last 3 years in our institution. Depending on the pattern of spastcity displayed, numerous peripheral nerves in the upper and lower extremities can be targeted. Majority of patients reported subjective benefits . Post-procedure adverse effect rates were low (<4%).