Long-term upper extremity performance in children with cerebral palsy following selective dorsal rhizotomy

Mortenson, Patricia; Sadashiva, Nishanth; Tamber, Mandeep S.; Steinbok, Paul

doi:10.1007/s00381-020-05018-2

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…For instance, a study of 61 patients between the ages of 5 and 41 found that there were no significant differences in outcomes among the different age groups, as each age group appeared to benefit from improvements in range of motion following surgery ( 17 ). Mortenson et al reported that younger patients had greater functional improvements in upper extremity function following selective dorsal rhizotomy ( 18 ). However, other studies have found that older children aged 10–12 experienced the greatest improvement in gait following surgical treatment ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery?

Song,

Saad,

Hutnik

et al. 2024

Front. Surg.

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PurposeSurgical treatments such as tendon transfers and muscle lengthening play a significant role in cerebral palsy management,but timing of upper extremity cerebral palsy surgery remains controversial. This study systematically reviews the current literature and investigates the correlation between age at surgery and follow-up time with surgical outcomes in pediatric upper extremity cerebral palsy patients.MethodsA comprehensive search of PubMed, Cochrane, Web of Science, and CINAHL databases was performed from inception to July 2020 and articles were screened using PRISMA guidelines to include full-text, English papers. Data analysis was performed using itemized data points for age at surgery, follow-up length, and surgery outcomes, reported as changes in active forearm and wrist motion. A 3D linear model was performed, to analyze the relationship between age, follow-up length, and surgery outcomes.ResultsA total of 3,855 papers were identified using the search terms and a total of 8 studies with itemized patient data (n=126) were included in the study. The studies overall possessed moderate bias according to the ROBINS-I scale. Regression analysis showed that age is a significant predictor of change (|t| > 2) in active forearm supination (Estimate = −2.3465, Std. Error = 1.0938, t-value= −2.145) and wrist flexion (Estimate = −2.8474, Std. Error = 1.0771, t-value = −2.643) post-intervention, with older individuals showing lesser improvements. The duration of follow-up is a significant predictor of improvement in forearm supination (Estimate = 0.3664, Std. Error = 0.1797, t-value = 2.039) and wrist extension (Estimate = 0.7747, Std. Error = 0.2750, t-value = 2.817). In contrast, forearm pronation (Estimate = −0.23756, Std. Error = 0.09648, t-value = −2.462) and wrist flexion (Estimate = −0.4243, Std. Error=0.1859, t-value = −2.282) have a significant negative association with follow-up time.ConclusionThese results suggest that there is significant correlation between the age and follow up after surgery with range of motion gains. Most notably, increased age at surgery had a significant negative correlation with select active range of motion postoperative outcomes. Future research should focus on identifying other factors that could affect results of surgical treatment in upper extremity.

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Section: Discussionmentioning

confidence: 99%

A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery?

Song,

Saad,

Hutnik

et al. 2024

Front. Surg.

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“…22 In SDR, the transection of dorsal lumbar rootlets is thought to cause an overall reduction in Ia sensory input to the spinal cord interneurons that not only affects the lumbar region, but also ascends up the spinal cord to the brainstem and cerebral cortex, thereby resulting in the widely observed "supra-segmental effects." 23,24…”

Section: Spasticity and Caregiver Burdenmentioning

confidence: 99%

Comparison of intrathecal baclofen pump insertion and selective dorsal rhizotomy for nonambulatory children with predominantly spastic cerebral palsy

Mansur¹,

Morgan

Lavigne

et al. 2022

Journal of Neurosurgery: Pediatrics

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OBJECTIVE In nonambulatory children with predominantly spastic cerebral palsy (CP), the authors compared care needs, symptom burden, and complications after surgical treatment with either intrathecal baclofen (ITB) pump insertion or selective dorsal rhizotomy (SDR). The patients were treated at two Canadian centers with variability in practice pertaining to these surgical options. METHODS The authors performed a retrospective analysis of nonambulatory children with predominantly spastic quadriplegic or diplegic CP who underwent treatment with ITB or SDR. These two strategies were retrospectively assessed by comparing patient data from the two treatment groups for demographic characteristics, outcomes, and complications. A partial least-squares analysis was performed to identify patient phenotypes associated with outcomes. RESULTS Thirty patients who underwent ITB and 30 patients who underwent SDR were included for analysis. Patients in the ITB group were older and had lower baseline functional status, with greater burdens of spasticity, dystonia, pain, deformity, bladder dysfunction, and epilepsy than patients in the SDR group. In addition, children who underwent SDR had lower Gross Motor Function Classification System (GMFCS) levels and were less likely to experience complications than those who underwent ITB. However, children treated with SDR had fewer improvements in pain than children treated with ITB. A single significant latent variable explaining 88% of the variance in the data was identified. CONCLUSIONS Considerable baseline differences exist within this pediatric CP patient population. Factors specific to individual children must be taken into account when determining whether ITB or SDR is the appropriate treatment.

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“…This hypothesis is counter to the predominant thinking that all of the "motor" functions, noted above are controlled largely by the brain, rather than the spinal cord. Ironically, proprioception is considered to be a major contributor to the spasticity in CP, and, therefore, is a primary target to reduce the tonic stiffness by performing selective dorsal root rhizotomy (Mortenson et al, 2021). However, selective rhizotomy minimizes the sensor input, which normally plays a prominent role in controlling movements and can disrupt autonomic functions.…”

Section: Solutionmentioning

confidence: 99%

Engaging Spinal Networks to Mitigate Supraspinal Dysfunction After CP

2021

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Although children with cerebral palsy seem to have the neural networks necessary to generate most movements, they are markedly dysfunctional, largely attributable to abnormal patterns of muscle activation, often characterized as spasticity, largely reflecting a functionally abnormal spinal-supraspinal connectivity. While it is generally assumed that the etiologies of the disruptive functions associated with cerebral palsy can be attributed primarily to supraspinal networks, we propose that the more normal connectivity that persists between peripheral proprioception-cutaneous input to the spinal networks can be used to guide the reorganization of a more normal spinal-supraspinal connectivity. The level of plasticity necessary to achieve the required reorganization within and among different neural networks can be achieved with a combination of spinal neuromodulation and specific activity-dependent mechanisms. By engaging these two concepts, we hypothesize that bidirectional reorganization of proprioception-spinal cord-brain connectivity to higher levels of functionality can be achieved without invasive surgery.

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Long-term upper extremity performance in children with cerebral palsy following selective dorsal rhizotomy

Cited by 7 publications

References 27 publications

A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery?

A PRISMA-IPD systematic review and meta-analysis: does age and follow-up improve active range of motion of the wrist and forearm following pediatric upper extremity cerebral palsy surgery?

Comparison of intrathecal baclofen pump insertion and selective dorsal rhizotomy for nonambulatory children with predominantly spastic cerebral palsy

Engaging Spinal Networks to Mitigate Supraspinal Dysfunction After CP

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