A review of orthopedic surgeries after selective dorsal rhizotomy

Abstract

<jats:p>✓ Selective dorsal rhizotomy (SDR) is an evidence-based treatment for cerebral palsy (CP) spasticity. During their lifetime, patients with CP spasticity may require orthopedic surgery for muscles and joints to correct physical deformities and provide a better quality of life. In this review, the authors discuss the timing of such orthopedic surgery, its necessity, and whether it is influenced by the performance of SDR. A review of findings from the authors' 19 years of experience yields the following conclusions: 1) that SDR reduces orthopedic surgery requirements when compared with historical controls; 2) that SDR performed in patients at a young age (2–4 years) can reduce future orthopedic surgery requirements; 3) that independent walkers and diplegic patients will have the smallest amount of orthopedic surgery post-SDR; and 4) that patients who need assistance walking and those with quadriplegia will have the greatest amount, although the frequency of orthopedic surgery for quadriplegic patients is not as high as popularly believed.</jats:p>

Functional outcomes of childhood dorsal rhizotomy in adults and adolescents with cerebral palsy

“…6 Global, or overall, life satisfaction was assessed us-ing the Diener SWLS, which rates 5 statements on a 7-point scale. 31 Total summary scores were interpreted as follows: extremely satisfied with life (31)(32)(33)(34)(35), satisfied (26)(27)(28)(29)(30), slightly satisfied (21)(22)(23)(24)(25), neutral (20), slightly dissatisfied (15)(16)(17)(18)(19), dissatisfied (10)(11)(12)(13)(14), and extremely dissatisfied (5)(6)(7)(8)(9). The reliability of this scale has been reported to be greater than 0.80.…”

Gait status 17–26 years after selective dorsal rhizotomy

“…The outcomes of SDR have also been compared with other spasticity reducing interventions like intrathecal baclofen [9] or physiotherapy [10,11], with better results demonstrated in the SDR groups for muscle tone, lower limb joint range of motion, and functional levels. In addition, SDR has been shown to reduce the number of necessary orthopaedic surgeries [12,13]. However, all of these studies analysed shortterm outcomes.…”

Single-level selective dorsal rhizotomy for spastic cerebral palsy

“…There is very little research comparing the two approaches, but O'Brien and Park have reported the need for less postoperative spinal stabilisation after introducing the singlelevel technique (12). In a retrospective case series comparing single-level laminectomy with multi-level laminectomy, Ou et al found that length of hospital stay was the only significant difference between the two approaches (13).…”