Evaluation of Percutaneous Cryoneurotomy Compared to Surgical Open Neurotomy for the Management of Equinovarus Foot Deformity in Patients With Refractory Lower Limb Spasticity After Stroke

Prior treatment

• Patient with previous nerve procedures such as chemical neurolysis with alcohol, cryoneurotomy, or any surgery at the same anatomical site.
• Patient with botulinum toxin in lower limb injection during the last 90 days before intervention.
• Patient with anti-spastic treatment (baclofene) up 3 days before block test.
• Pregnant woman, nursing mother, woman of childbearing potential not using effective contraception (hormonal/barrier: oral, parenteral, percutaneous, implantable, intrauterine device, or surgical: tubal ligation, hysterectomy, total ovariectomy).

Other illness

• Surgical and anesthetic contra-indications (severe uncontrolled coagulation disorder, active infection).
• Cryoneurotomy contra-indications (cold intolerance, cryoglobulinemia, cryofibrinogenemia, Raynaud's phenomena, venous thromboemolism (\< 3 months if superficial, \< 6 months if deep), hypothyreosis, cold urticari, local disorders of blood supply, considerable anemia, cachexia, hypothermia, cancer disease, infection, coagulopathy…).).

Other

• Patient with any neurological pathology different from the one responsible for the spasticity.
• Patient with total deficit of valgus muscles.
• Patient with equinus foot \> 40° (retractions/ankylosis).
• Subject requiring closer protection, i.e. minors, pregnant women, nursing mothers, subjects deprived of their freedom by a court or administrative decision, subjects admitted to a health or social welfare establishment, major subjects under legal protection (temporary or permanent guardianship and, subject to subordination), and finally patients in an emergency setting.

• Age ≥18 years old.
• Patient with spastic equinovarus foot as a result of stroke in chronic phase (\>6 months).
• Patient with positive perineural motor block test with or without complete correction of spastic equinus and non-persistence of 40° equinus.
• Patient eligible for surgical neurotomy for varus equinus foot.
• Patient presenting no cognitive impairment or major depression (Mini Mental State Examination\>20, Hospital Anxiety and Depression (HAD\<11)).
• Absence of active psychosis or history of serious psychotic illness requiring hospitalization
• Patient understanding and accepting the constraints of the study.
• Patient covered by French national health insurance.
• Patient who has given their written consent to the study after having received clear information.