Assessment of 30-Day Adverse Events in Single-Event, Multilevel Upper Extremity Surgery in Adult Patients with Upper Motor Neuron Syndrome

Abstract

Background: Upper motor neuron (UMN) syndrome consists of muscle spasticity, weakness, and dyssynergy due to a brain or spinal cord injury. The purpose of this study is to describe the perioperative adverse events for adult patients undergoing single-event, multilevel upper extremity surgery (SEMLS) due to UMN syndrome. Methods: A retrospective case series was performed for 12 consecutive adult patients who underwent SEMLS to correct upper extremity dysfunction or deformity secondary to UMN syndrome. The evaluation consisted of primary outcome measures to identify readmission rates and classify adverse events that occurred within 30 days after surgery. Results: All 12 patients were functionally dependent with 50% (n = 6) men and 50% (n = 6) women at a mean age of 43.6 years (range: 21-73) with a mean of 5.92 (range: 0-16) comorbid diagnoses at the time of surgery. There were no intraoperative complications, hospital readmissions, or deaths among the 12 patients. Five patients experienced 5 minor postoperative complications that consisted of cast- or orthosis-related skin breakdown remote from the incision (n = 3), incidental surgical site hematoma that required no surveillance or intervention (n = 1), and contact dermatitis attributed to the surgical dressing that resolved with topical corticosteroids (n = 1). Conclusions: With an appropriate multidisciplinary approach, there is minimal risk for developing perioperative and 30-day postoperative adverse events for adults undergoing SEMLS to correct upper extremity deformities secondary to UMN syndrome. Level of Evidence: IV

Expert consensus on the surgical evaluation and management of upper extremity spasticity in adults

“…Considerations for whether or not to stage procedures include goals of care, resources available (e.g. personal finance, insurance coverage, travel requirements), medical complexity of the patient and the surgical teams’ experience and protocol (Patel and Rhee, 2022).…”

Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury

“… 1 , 2 This dysregulation of motor tone and muscle activation occurs as a result of damage to inhibitory upper motor neurons (UMNs). 3 The cause of UMN injury includes cerebral palsy (CP), stroke, multiple sclerosis (MS), and spinal cord injury (SCI). The estimated prevalence of spasticity in CP is 1.78 per 1000 patients, and most (69.8%) children with CP experience spasticity.…”

“…Spasticity is a motor disorder characterized by a velocity-dependent increase in muscle tone with an exaggerated tendon jerk resulting from hyperexcitability of the stretch reflex, as first defined by Lance in 1980 1,2 . This dysregulation of motor tone and muscle activation occurs as a result of damage to inhibitory upper motor neurons (UMNs) 3 . The cause of UMN injury includes cerebral palsy (CP), stroke, multiple sclerosis (MS), and spinal cord injury (SCI).…”