Percutaneous Cryoneurolysis as a Dynamic Treatment for Spasticity: A Case Series.
Clay C Guynn
PMID 40463785WHAT IT FOUND
In ten patients with spasticity from stroke, cerebral palsy, or other causes, percutaneous cryoneurolysis was associated with immediate and sustained reductions in muscle tone and pain.
However, concurrent therapies were often used, so the specific contribution of cryoneurolysis alone cannot be determined.
Key findings
01Patients across various etiologies of spasticity (stroke, cerebral palsy, multiple sclerosis, idiopathic) reported immediate improvements in gait, range of motion, and pain following ultrasound-guided cryoneurolysis.
02Modified Ashworth Scale scores improved immediately after the procedure in all cases, with some patients sustaining these improvements for up to one year.
03Several patients had previously failed or could not tolerate standard treatments like botulinum toxin, oral medications, or splinting before undergoing cryoneurolysis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a small case series (n=10) with no control group, so causality cannot be established. Many patients received concurrent interventions such as physical therapy, orthotics, or electrical stimulation, making it impossible to isolate the effect of cryoneurolysis. Follow-up duration varied, and outcome measures were not standardized across all cases. The device is not approved for treating central nervous system tissues, raising questions about off-label use and generalizability. Patient selection bias is likely, as many had failed prior treatments and may have been motivated for a novel option.
Declared interests
One author is a paid consultant for Pacira BioSciences, Inc., the manufacturer of the iovera° device used in the study. The device is not approved for the indications reported.
The easy way to misread this
Do not conclude that cryoneurolysis alone caused the observed improvements. Many patients received concurrent physical therapy, orthotics, or other interventions, and the study lacks a control group. The positive outcomes may reflect the combined effect of multiple treatments rather than the procedure itself.