The objective of this review is to analyze the evidence supporting selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy (CP). We reviewed 85 outcome studies from 12 countries between 1990 and 2017. The published results are overwhelmingly supportive of SDR, and 39 studies form a basis for this review. Also included is some of the clinical experience of the senior author.The results show that SDR plus postoperative physiotherapy (PT) improved gait, functional independence, and self-care in children with spastic diplegia. In adults with a follow-up of 20 to 28 years, the early improvements after childhood SDR were sustained and improved quality of life. Furthermore, majority of the adults who underwent SDR as children would recommend SDR to others. On the clinical side, while SDRs through multilevel laminectomies or laminoplasty were associated with spinal deformities (i.e., scoliosis, hyperlordosis, kyphosis, spondylolisthesis, spondylolysis, and nonhealing of laminoplasty), SDRs through a single level laminectomy prevented SDR-related spinal problems. The outcomes of SDR specific to spastic quadriplegia require further investigation because of the relatively small patient population with quadriplegia. Lastly, we found that SDR can prevent or reverse premature aging in adolescents and adults with spastic diplegia. In conclusion, the evidence supporting the efficacy of SDR is strong, and SDR is a well-established option for spasticity management in spastic CP.

Introduction/aims: Determine established neuromuscular disease patients' satisfaction with telehealth during the COVID-19 pandemic.Methods: We received 50 completed Utah telehealth satisfaction surveys from a cohort of 90 from April 2020 to June 2020. Returning neuromuscular disease patients rated seven aspects from 1 (strongly disagree) to 5 (strongly agree): Communication, timeliness of physician, picture quality, sound quality, protection of privacy, the comfort of the physical exam, the ease of healthcare, and whether patients would prefer “in-person” visits despite safety precaution. A favorable response was defined as a response of “Agree” or “Strongly Agree” to the survey questions. An independent t-test, Fisher's or chi-square test were used to compare demographic factors on outcomes for each survey question.Results: The average age was 47.54 ± 20.63, 54% were female, 70% from rural areas, 60% had family present “webside,” and 14% had family present remotely. The majority of patients reported “Agree” or “Strongly Agree” to each survey question assessing their telehealth satisfaction, except for whether patients preferred in-person appointments. Demographic factors, including location and clinical diagnosis, did not influence survey responses.Discussion: The vast majority of established neuromuscular disease patients responded favorably to their telehealth experience during the COVID-19 pandemic.

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Background: Intrathecal baclofen (ITB) administration via an implanted programmable pump and selective dorsal rhizotomy (SDR) are both used for the treatment of cerebral palsy (CP) spasticity.Objective: To examine whether SDR can improve ambulation in children who have been receiving ITB therapy for spastic cerebral palsy.Methods: We reviewed 13 patients who received prior ITB placement with subsequent simultaneous SDR and ITB removal. Patients also completed a follow-up survey to document long-term motor function.Results: In our 13-patient cohort, patients received ITB treatment for an average of 4.4 \begin{document}\pm\end{document} 1.8 years and the mean age of ITB removal/SDR was 12.5 \begin{document}\pm\end{document} 5.8 years. The follow-up period ranged from 3 to 19 months (mean duration: 6.9 \begin{document}\pm\end{document} 5 months). Pre-operatively, all patients had Gross Motor Function Classification System (GMFCS) scores between 2 and 4. Nine patients were diagnosed with spastic diplegia, two had spastic triplegia and two had spastic quadriplegia. SDR and ITB removal led to improved lower limb spasticity and ambulation. GMFCS scores remained stable in all patients. One patient developed a cerebrospinal fluid (CSF) collection in the abdominal wall due to a CSF leak from the baclofen pump site. All 11 patients who completed the follow-up survey noted improved motor function.Conclusion: This study demonstrates that SDR can reduce spasticity and improve mobility after years of ITB treatment for spastic cerebral palsy.