LONG-TERM EFFICACY OF SPASTICITY-CORRECTIVE SURGERY AND BOTULINUM TOXIN INJECTIONS FOR UPPER LIMB SPASTICITY TREATMENT.

OBJECTIVE

To evaluate the long-term efficacy of spasticity-corrective surgery and botulinum toxin treatment in patients with upper limb spasticity.

DESIGN

Pretest-posttest quasi-experimental study.

PATIENTS

Thirty-four patients with disabling spasticity.

METHODS

Patients were divided into 2 groups based on their treatment preference: the surgery group, which underwent tendon lengthening/release ( = 17), and the botulinum toxin injection group ( = 17). The primary outcome measure was the Modified Ashworth Scale. Secondary outcomes included range of motion, grip strength, and activity performance. Assessments were conducted at baseline for both groups, at 3 months following botulinum toxin injection, and at 6 months following surgery, with an additional peak-effect evaluation for botulinum toxin at week 5.

RESULTS

The surgery group demonstrated significantly greater reductions in composite Modified Ashworth Scale scores, with a mean change of 2.7 (SD 0.8), compared to the botulinum toxin group (1.1, SD 0.6 at peak; 0.3, SD 0.5 at long-term; < 0.001). Surgery also led to significantly larger improvements in range of motion, grip strength, task performance, and patient satisfaction. While botulinum toxin effects were transient, surgery provided sustained benefits.

CONCLUSION

Spasticity-corrective surgery achieves superior and longer-lasting benefits compared to botulinum toxin treatment in patients with disabling upper limb spasticity.