Alcohol neurolysis of the sciatic nerve in the treatment of hemiplegic knee flexor spasticity: clinical outcomes

OBJECTIVE: To study clinical outcomes after 50% to 100% alcohol neurolysis of the sciatic nerve in the treatment of chronic hemiplegic knee flexor spasticity. DESIGN: Case series using a convenience sample. SETTING: Rehabilitation teaching hospital. PATIENTS: Eight patients (mean age, 55.1 +/- 12.1 yr; mean duration to block, 4.4 +/- 3.7 mo) with chronic hemiplegia and severe spasticity (modified Ashworth scale [MAS] score < 2) secondary to cerebrovascular accidents (n = 5) and traumatic brain injuries (n = 3). Two patients were ambulant, 6 were wheelchair-bound. INTERVENTIONS: Fifty percent to 100% alcohol neurolysis of the sciatic nerve using repetitive electric stimulation to localize the sciatic nerve. MAIN OUTCOME MEASURES: MAS score, gain in knee range of motion (ROM), and visual inspection of gait at 0, 1, and 6 months postneurolysis. Nonparametric tests were used in statistical analysis. RESULTS: The mean preinjection MAS score was 2.8 +/- 0.7, which improved to 1.4 +/- 0.7 at 1 month (p = .005), and 1.8 +/- 0.9 (p = .01) and 1.9 +/- 1.1 (p = .02) at 3 and 6 months postinjection, respectively. The mean gain in knee ROM was 34.4 degrees +/- 15.7 degrees at 1 month postinjection and was maintained at 6 months postinjection. Improvements in gait were noted in both ambulant patients, and improved positioning in 3 of 6 wheelchair-bound patients. The incidence of dysesthetic pain was 0%. CONCLUSION: Fifty percent to 100% alcohol neurolysis of the sciatic nerve is a safe and effective method for treatment of hemiplegic knee flexor spasticity, with therapeutic effects lasting 6 months.