Functional decline in children undergoing selective dorsal rhizotomy after age 10

Baker, Richard; Graham, Kerr

doi:10.1111/j.1469-8749.2011.04020.x

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…Orthopedic surgery should follow SPR [87]. Similarly, Baker and Graham [88] revealed that the selection and sequence of orthopedic surgery or SPR should be based on the surgical indications and natural growth and development curve of children with CP. In preschool, limb deformities of children are mainly caused by spasticity and primarily characterized by weak muscle strength and secondary skeletal dysplasia from school age to adolescent stage.…”

Section: Surgical Treatment 31 Selective Posterior Rhizotomymentioning

confidence: 99%

Orthopedic treatment of the lower limbs in spastic paralysis

Deng

Zeng

et al. 2020

Brain Science Advances

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Spastic paralysis of the limb mainly results from the central lesion, in which spastic cerebral palsy is the common cause. Due to durative muscle spasm in spastic cerebral palsy, it is often accompanied by the formation of secondary musculoskeletal deformities, resulting in limb motor disability. Based on its pathogenesis, surgical treatment is currently applied: selective posterior rhizotomy (SPR) or orthopedic surgery. The primary purpose of early orthopedic surgery was simply to correct limb deformities, which usually led to the recurrence of deformity as a result of the presence of spasticity. With the application of SPR, high muscle tone was successfully relieved, but limb deformity was still present postoperatively. Therefore, this study aimed to elaborate on the management of orthopedic surgery, common deformities of the lower limb, and orthopedic operative methods; discuss the relationship between SPR and orthopedic procedure for limb deformity; and focus on the indications, timing of intervention, and postoperative outcome of different surgical methods.

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Section: Surgical Treatment 31 Selective Posterior Rhizotomymentioning

confidence: 99%

Orthopedic treatment of the lower limbs in spastic paralysis

Deng

Zeng

et al. 2020

Brain Science Advances

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“…16 Clinical studies have demonstrated that SDR results in short-and long-term improvement in lower-extremity tone and can lead to improved mobility, improved lower-limb function, decreased need for orthopedic surgical interventions, and an increased level of self-care for children with spastic diplegia and spastic quadriplegia. 2,5,7,8,10,12,15,18,19 Although nerve rootlet transection is limited to the lumbosacral rootlets in SDR, early anecdotal reports in the 1980s suggested the unexpected observation of improvements above the level of the lower extremities, termed "suprasegmental effects." Over the next decade, a number of small case series emerged describing improvement in upper-extremity function or tone following SDR, but only described qualitative improvement or quantitative improvement in select upper-extremity muscle groups.…”

Section: ©Aans 2013mentioning

confidence: 99%

Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy

Gigante¹,

McDowell

Bruce

et al. 2013

PED

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Object Randomized clinical trials have established that lumbar selective dorsal rhizotomy (SDR) reduces lower-extremity tone and improves functional outcome in children with spastic cerebral palsy. Significant data exist to support a secondary effect on upper-extremity function in patients with upper-extremity spasticity. The effects of SDR on upper-extremity tone, however, are not well characterized. In this report, the authors sought to assess changes in upper-extremity tone in individual muscle groups after SDR and tried to determine if these changes could be predicted preoperatively. Methods The authors retrospectively reviewed 42 children who underwent SDR at Columbia University Medical Center/Morgan Stanley Children's Hospital of NewYork-Presbyterian between 2005 and 2011. Twenty-five had upper-extremity spasticity. All underwent pre- and postoperative examination for measuring tone (Modified Ashworth Scale) and assessing functional outcome. Follow-up examinations with therapists were performed at least once at a minimum of 2 months postoperatively (mean 15 months). Results In the upper extremities, 23 (92%) of 25 patients had improvements of at least 1 Ashworth point in 2 or more independent motor groups on the Modified Ashworth Scale, and 12 (71%) of 17 families surveyed reported increases in motor control or spontaneous movement. The mean Modified Ashworth Scale scores for all upper-extremity muscle groups demonstrated an improvement from 1.34 to 1.22 (p < 0.001). Patients with a mean preoperative upper-extremity tone of 1.25–1.75 were most likely to benefit from reduction in tone (p = 0.0019). Proximal and pronator muscle groups were most likely to demonstrate reduced tone. Conclusions In addition to improvements in lower-extremity tone and function, SDR has demonstrable effects on upper extremities. Greater than 90% of our patients with elevated upper-extremity tone demonstrated reduction in tone in at least 2 muscle groups postoperatively. Patients with a mean Modified Ashworth Scale upper-extremity score of 1.25–1.75 may encounter the greatest reduction in upper-extremity tone.

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“…Interpretation: This suggests that age greater than 10 years might be a contraindication for SDR if the goal is to improve motor skills.” [What other rationale?] The designated editorial authors 17 display popular opinion:“Selective dorsal rhizotomy (SDR) is now a well-accepted option for spasticity management in children with cerebral palsy. The evidence-base for this is provided by three classic randomized control trials and a subsequent meta-analysis.…”

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confidence: 99%

Rootless Century

Landau

2012

J Child Neurol

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The tendency of children to improve coordination and function with increasing age must be distinguished from the effect of treatment.'' R.S. Paine 1 With reference search to 1888, Professor Otfrid Foerster read his extensive review ''On the Indications and Results of the Excision of Posterior Spinal Nerve Roots in Men'' 2 before the Third Clinical Congress of Surgeons in North America, New York City, November 2, 1912. Why women were excluded from the benefits of this procedure was not explained; the figures include 25 photographs of posed naked boys. Foerster defined 3 purposes for the procedure: ''The first indication for the excision of the posterior spinal nerve roots is based upon the physiological function of the same, as conductors of the sensibility, and is formed by violent neuralgic pains, which defy other methods of relief.. .. .'' Results: Successful, 12 cases; failures, 23 cases; result unknown, 3 cases.. .. The second indication for resection of posterior spinal nerve roots is the visceral, especially the gastric, crises in tabes.. .. The third indication for resection of posterior roots is spasticity and spastic paralysis due to a disease of the corticospinal path, especially the pyramidal tract. I will not here recur to the physiological point of view and the pathologico-anatomical ''facts which have led me to propose the resection of posterior roots for the relief of spasticity.. . .'' ''Mortality of 8.8%. The mortality appears still less when considering the results of a single operator like Küttner, who had only two deaths among 31 cases operated for spasticity. Both were children with severe epilepsy; an epileptic attack followed the first stage of the operation.. .. I counted 88 cases of congenital spastic paralysis treated by resection of posterior lumbar and sacral roots, with 6 deaths. In a large majority the results have been satisfactory, part even excellent. The causes of failure will be discussed later on.. .. I should like to demonstrate to you, in pictures, the extent of the improvement in some cases operated by Küttner and treated by me.. .. Case 1. Boy, age 7. Severest rigidity of the limbs (Fig. 7); unable to make the slightest voluntary movement

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Functional decline in children undergoing selective dorsal rhizotomy after age 10

Cited by 5 publications

References 7 publications

Orthopedic treatment of the lower limbs in spastic paralysis

Orthopedic treatment of the lower limbs in spastic paralysis

Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy

Rootless Century

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