Intraoperative monitoring during selective posterior rhizotomy: technique and patient outcome

Staudt, Loretta A.; Nuwer, Marc R.; Peacock, Warwick J.

doi:10.1016/0924-980x(95)00128-8

Cited by 42 publications

(41 citation statements)

References 24 publications

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“…In spastic diplegic children, the range of motion and ambulatory status improved as well [37]. Other studies revealed an increased range of motion in the lower extremities and reduced spasticity [38, 39, 40]. Engsberg et al [41]found a reduction in ankle spasticity and no decrease in strength in children with cerebral palsy.…”

Section: Outcomes Of Posterior Rhizotomymentioning

confidence: 92%

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

et al. 2001

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Spasticity occurs in children and adults due to a wide range of conditions, including cerebral palsy, head and spinal cord trauma, cerebrovascular accidents and multiple sclerosis. Multiple treatment options have been described, including medical and surgical treatments. Medical treatments include intramuscular botulinum A toxin, oral baclofen and supportive bracing. Surgical approaches include selective posterior rhizotomy, intrathecal baclofen and orthopedic procedures to address deformities. Many reports have been published on these different treatment options, but rarely has a comparison been made between them. Therefore, this review is aimed at comparing selective posterior rhizotomy and intrathecal baclofen injection for spasticity due to cerebral palsy, especially in children.

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Section: Outcomes Of Posterior Rhizotomymentioning

confidence: 92%

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

et al. 2001

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“…In order to quantify spasticity in children with CP subjective quantification of muscle tendon reflexes and modifications of the Ashworth scale have been used (Peacock and Staudt 1991, Staudt et al 1995, Steinbok et al 1997, McLaughlin et al 1998, Wright et al 1998. A hand-held force transducer or myometer has been used to quantify resistance to passive motion (Staudt et al 1995). Biomechanical measurements, such as the spasticity measurement system (SMS; Lehmann et al 1989) have been used for quantification of the plantar flexors (Price et al1991).…”

mentioning

confidence: 99%

“…New techniques to treat spasticity in children with CP, such as selective dorsal rhizotomy (SDR), botulinum toxin injections, intrathecal baclofen infusion, and peroral drug therapy require assessment tools to monitor their effectiveness (Hinderer and Gupta 1996, Forssberg and Tedroff 1997, Hesse and Mauritz 1997. In order to quantify spasticity in children with CP subjective quantification of muscle tendon reflexes and modifications of the Ashworth scale have been used (Peacock and Staudt 1991, Staudt et al 1995, Steinbok et al 1997, McLaughlin et al 1998, Wright et al 1998. A hand-held force transducer or myometer has been used to quantify resistance to passive motion (Staudt et al 1995).…”

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confidence: 99%

Wartenberg pendulum test: objective quantification of muscle tone in children with spastic diplegia undergoing selective dorsal rhizotomy

Nordmark

Andersson

2002

Develop Med Child Neuro

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The aim of this study was to investigate the reliability and sensitivity of the Wartenberg pendulum test for quantification of muscle tone in young children with spastic diplegia undergoing selective dorsal rhizotomy (SDR). Fourteen non‐disabled children (mean age of 5.5 years, age range 2.3 to 8.8 years, one female and one male in each year) were tested twice. Twenty children with spastic diplegia (12 males, eight females; mean age of 4.3 years, age range 2.5 to 6.3 years) consecutively selected for SDR, were assessed before and 6 months after SDR. Parameters of the pendulum test: R2, R1, maximal velocity, and swing time were correlated with clinical assessments for spasticity (modified Ash worth scale, quadriceps reflex) and measurements of gross motor function: the Gross Motor Function Classification System and the Gross Motor Function Measure. The Wartenberg pendulum test was found to be an objective and sensitive method for quantifying spasticity in knee extensor muscles in children as young as 2.5 years old. The method was responsive to changes after SDR. The only correlation with clinical measurements of spasticity was between the R2 ratio and the quadriceps reflex. Swing time was the most reliable and sensitive variable; it showed a weak correlation with measurements for gross motor function.

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“…These muscle groups were chosen as being representative of the major lower extremity muscle groups and consistent with historic controls [13, 14]. The marked decrease in lower extremity spasticity probably contributed to the statistically significant increase in stride length.…”

Section: Discussionmentioning

confidence: 99%

Nonselective Partial Dorsal Rhizotomy: A Clinical Experience with 1-Year Follow-Up

2000

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The ability to perform a ‘selective’ dorsal rhizotomy has been challenged. EMG responses are inconsistent and often do not represent reflex responses. We perform nonselective partial dorsal rhizotomy (NSPDR) when reflex response is not evident. Ten children undergoing primarily NSPDR were evaluated preoperatively and postoperatively with the Modified Ashworth Scale, gait lab analyses gross motor function measure and the NSPDR was performed by nonselectively sectioning 50–75% of the dorsal roots not demonstrating a reflex response. Standard selective rhizotomy was performed in the remainder. Only 17 of 106 (16%) dorsal roots demonstrated reflex responses. The results reported in this study demonstrate a benefit to patients undergoing primarily NSPDR which is similar to that reported for patients in whom a selective procedure was intended.

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Intraoperative monitoring during selective posterior rhizotomy: technique and patient outcome

Cited by 42 publications

References 24 publications

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

Wartenberg pendulum test: objective quantification of muscle tone in children with spastic diplegia undergoing selective dorsal rhizotomy

Nonselective Partial Dorsal Rhizotomy: A Clinical Experience with 1-Year Follow-Up

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