Evidence Supporting Selective Dorsal Rhizotomy for Treatment of Spastic Cerebral Palsy

Park, T S; Dobbs, Matthew B.; Cho, Junsang

doi:10.7759/cureus.3466

Cited by 30 publications

(32 citation statements)

References 40 publications

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“…EMG electromyography, SD standard deviation, mA milliampere, ms millisecond Table 3 Changes of muscle tone, muscle strength of the target muscles, and ROM of the joints involved (passive) pre-and postop favorable outcome. Similar results were reported from other centers when SDR was performed in the traditional manner [14][15][16][17]. Further investigation in our study revealed that cases when SDR performed to younger than 6 years old had much Fig.…”

Section: Discussionsupporting

confidence: 91%

Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?

Zhan

Jiang

et al. 2019

Childs Nerv Syst

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Purpose Our aim was to test whether the newly modified rhizotomy protocol which could be effectively used to guide single-level approach selective dorsal rhizotomy (SL-SDR) to treat spastic hemiplegic cases by mainly releasing those spastic muscles (target muscles) marked pre-operatively in their lower limbs was still applicable in spastic quadriplegic or diplegic cerebral palsy (CP) cases in pediatric population. Methods In the current study, we retrospectively conducted a cohort review of cases younger than 14 years of age diagnosed with spastic quadriplegic or diplegic CP who undergone our modified protocol-guided SL-SDR in the Department of Neurosurgery, Children’s Hospital of Shanghai since July 2016 to November 2017 with at least 12 months post-op intensive rehabilitation program (pre-op GMFCS level-based). Clinical data including demographics, intra-operative EMG responses interpretation, and relevant assessment of included cases were taken from the database. Inclusion and exclusion criteria were set for the selection of patients in the current study. Muscle tone (modified Ashworth scale) and strength of those spastic muscles (muscle strength grading scale), range of motion (ROM) of those joints involved, the level of Gross Motor Function Classification System (GMFCS), and Gross Motor Function Measure 66 items (GMFM-66) score of those cases were our focus. Results A total of 86 eligible cases were included in our study (62 boys). Among these patients, 61.6% were quadriplegic. Pre-operatively, almost 2/3 of our cases were with GMFCS levels II and III. Mean age at the time of surgery in these cases was 6.2 (3.5–12) years. Pre-op assessment marked 582 target muscles in these patients. Numbers of nerve rootlets tested during SDR procedure were between 52 and 84 across our cases, with a mean of 66.5 ± 6.7/case. Among those tested (5721 in 86 cases), 47.9% (2740) were identified as lower limb-related sensory rootlets. Our protocol successfully differentiated sensory rootlets which were considered to be associated with spasticity of target muscles across all our 86 cases (ranged from 3 to 21). Based on our protocol, 871 dorsal nerve rootlets were sectioned 50%, and 78 were cut 75%. Muscle tone of those target muscles reduced significantly right after SL-SDR procedure (3 weeks post- vs. pre-op, 1.7 ± 0.5 vs. 2.6 ± 0.7). After an intensive rehabilitation program for 19.9 ± 6.0 months, muscle tone continued to decrease to 1.4 ± 0.5. With the reduction of muscle tone, strength of those target muscles in our cases improved dramatically with statistical significance achieved (3.9 ± 1.0 at the time of last follow-up vs. 3.3 ± 0.8 pre-op), and as well as ROM. Increase in GMFCS level and GMFM-66 score was observed at the time of last follow-up with a mean of 0.4 ± 0.6 and 6.1 ± 3.2, respectively, when compared with that at pre-op. In 81 cases with their pre-op GMFCS levels II to V, 27 (33.3%) presented improvement with regard to GMFCS level upgrade, among which 4 (4.9%) even upgraded over 2 levels. Better results with regard to upgrading in level of GMFCS were observed in cases with pre-op levels II and III when compared with those with levels IV and V (24/57 vs. 3/24). Upgrading percentage in cases younger than 6 years at surgery was significantly greater than in those older (23/56 vs. 4/25). Cases with their pre-op GMFM-66 score ≥ 50 had greater score increase of GMFM-66 when compared with those less (7.1 ± 3.4 vs. 5.1 ± 2.8). In the meanwhile, better score improvement was revealed in cases when SDR performed at younger age (6.9 ± 3.3 in case ≤ 6 years vs. 4.7 ± 2.7 in case > 6 years). No permanent surgery-related complications were recorded in the current study. Conclusion SL-SDR when guided by our newly modified rhizotomy protocol was still feasible to treat pediatric CP cases with spastic quadriplegia and diplegia. Cases in this condition could benefit from such a procedure when followed by our intensive rehabilitation program with regard to their motor function.

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Section: Discussionsupporting

confidence: 91%

Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?

Zhan

Jiang

et al. 2019

Childs Nerv Syst

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“…The beneficial effects of the operation extend into adulthood [1,2]. Amassed evidence in the literature and clinical experience with the procedure in the last four decades indicate the efficacy of SDR in the treatment of spastic diplegia [3]. By contrast, there was only a single publication on the outcome of SDR on children with spastic hemiplegia.…”

Section: Introductionmentioning

confidence: 99%

Selective Dorsal Rhizotomy for the Treatment of Spastic Hemiplegic Cerebral Palsy

Ts¹,

Joh²,

Walter³

et al. 2020

Cureus

Self Cite

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Background Selective dorsal rhizotomy (SDR) can remove spasticity in cerebral palsy (CP). Spastic hemiplegia is associated with spasticity in the upper and lower limbs on one side. Only a single report described the outcome of SDR specifically in patients with spastic hemiplegic CP. The effect of SDR on spastic hemiplegia requires further investigation. Objectives To analyze the outcomes of motor functions, the quality of life, and satisfaction of patients who received SDR for the treatment of spastic hemiplegia. Methods A total of 29 children and 1 adult who received SDR were surveyed. The survey questionnaire asked about demographic information, patient's perception of SDR, functional outcomes, SDR surgical outcomes, pain, braces/orthotics, and post-SDR treatment.

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“…Las dimensiones de la calidad de vida en las que se han obtenido puntuaciones medias más bajas han sido: desarrollo personal, inclusión social y bienestar material. En un estudio llevado a cabo por Park et al, (19) también se encontraron medias inferiores en inclusión social pero en este caso la otra dimensión con una media inferior al resto fue la dimensión de relaciones interpersonales.…”

Section: Discussionunclassified

Calidad de vida en adultos institucionalizados con parálisis cerebral infantil

Martínez-Traver

Cervera‐Gasch²

2019

Enf Global

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Introduccion: La parálisis cerebral es considerada como un grupo de trastornos permanentes deldesarrollo que originan limitaciones en la actividad diaria. Una de las complicaciones en las personascon parálisis cerebral es la disminución de la calidad de vida.Objetivo: El objetivo de este estudio es conocer la calidad de vida de las personas adultas institucionalizadas con parálisis cerebral infantil y conocer si existen diferencias en el índice de calidad de vida en función de las características funcionales.Método: Estudio observacional descriptivo trasversal en personas adultas institucionalizas con parálisiscerebral infantil realizado en los centros APCA y ASPROPACE entre marzo y septiembre de 2017. Seadministró el cuestionario San Martín para medir la Calidad de Vida, Gross motor classification system,cuestionario Barthel, Escala CFCS para medir función motora, dependencia física, nivel decomunicación y relacionarlas con variables sociodemográficas y clínicas. La selección de lospariticipantes se llevó a cabo mediante un muestreo estratificado aleatorio. Se contó con la aprobaciónde las direcciones de los centros.Resultados: Participaron 39 personas con edad media de 32,54 años. La puntuación media global delcuestionario San Martin fue de 102,97 puntos. Las dimensiones mas afectadas fueron bienestar material, desarrollo personal e incluison social. No se obtuvo significación estadística en la puntuación global del cuestionario en función de las variables secundarias.Conclusiones: Los resultados de este estudio han demostrado que la Calidad de vida de adultos conparálisis cerebral en los sujetos estudiados es buena. Introduction: Cerebral palsy is considered a group of permanent developmental disorders that causelimitations in daily activity. One of the complications in people with cerebral palsy is the decrease inquality of life.Objective: The objective of this study is to know the quality of life for institutionalized adults withinfantile cerebral palsy and to know if there are differences in the quality of life index based on functionalcharacteristics.Method: Cross-sectional descriptive observational study in institutionalized adults with infantile cerebralpalsy performed in the APCA and ASPROPACE centers between March and September 2017. The SanMartín questionnaire was administered to measure the Quality of Life, Gross motor classificationsystem, Barthel questionnaire, Scale CFCS to measure motor function, physical dependence, level ofcommunication and relate them with sociodemographic and clinical variables. The selection of theparticipants was carried out by random stratified sampling. It was approved by the centers' addresses.Results: Participants were 39 people with an average age of 32.54 years. The overall average score ofthe San Martin questionnaire was 102.97 points. The most affected dimensions were material wellbeing,personal development and social incluison. No statistical significance was obtained in the overall score of the questionnaire based on the secondary variables.Conclusions: The results of this study have shown that the quality of life of adults with cerebral palsy inthe subjects studied is good.

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Evidence Supporting Selective Dorsal Rhizotomy for Treatment of Spastic Cerebral Palsy

Cited by 30 publications

References 40 publications

Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?

Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?

Selective Dorsal Rhizotomy for the Treatment of Spastic Hemiplegic Cerebral Palsy

Calidad de vida en adultos institucionalizados con parálisis cerebral infantil

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