Predictors for the benefit of selective dorsal rhizotomy

Funk, Julia F.; Panthen, Amelie; Bakır, Mustafa; Gruschke, Franziska; Sarpong, Akosua; Wagner, C. N. J.; Lebek, Susanne; Haberl, Ernst Johannes

doi:10.1016/j.ridd.2014.11.012

Cited by 28 publications

(21 citation statements)

References 24 publications

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“…Volunteers were ineligible if they underwent SDR at age 10 years or older or had any history of other spinal cord surgery. Only those whose SDR was performed before age 10 were included, to avoid confounding effects of age at time of surgery since older age at SDR has been linked to worse functional outcomes …”

Section: Methodsmentioning

confidence: 99%

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Long‐term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case–control study

Daunter

Kratz

Hurvitz

2017

Develop Med Child Neuro

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Aim Selective dorsal rhizotomy (SDR) is a surgical treatment for spasticity in children with cerebral palsy (CP). Studies suggest long-lasting effects of SDR on spasticity; long-term effects on symptoms and function are not clear. This study tested whether adults with CP (average 22y after SDR) report less pain, fatigue, and functional decline than a retrospectively assessed non-surgical comparison group. Method This was a case–control study. Eighty-eight adults with CP (mean age 27y 0mo; SDR=38; non-surgical [comparison]=50) recruited from a tertiary care center and the community completed a battery of self-reported outcome measures. Regression models were used to test whether SDR status predicted pain, fatigue, functional change, and hours of assistance (controlling for Gross Motor Function Classification System level). Results SDR status did not significantly predict pain interference (p=0.965), pain intensity (p=0.512), or fatigue (p=0.404). SDR related to lower decline in gross motor functioning (p=0.010) and approximately 6 fewer hours of daily assistance than for those in the comparison group (p=0.001). Interpretation Adults with CP who had SDR in childhood reported less gross motor decline and fewer daily assistance needs than non-surgically treated peers, suggesting the functional impact of SDR persists long after surgery.

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Section: Methodsmentioning

confidence: 99%

“…Only those whose SDR was performed before age 10 were included, to avoid confounding effects of age at time of surgery since older age at SDR has been linked to worse functional outcomes. 16,17…”

Section: Methods Participant Recruitmentmentioning

confidence: 99%

Long‐term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case–control study

Daunter

Kratz

Hurvitz

2017

Develop Med Child Neuro

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“…The mean age of the CP children at the day of surgery was 6 years 3 months with a standard deviation (SD) of 1 year 8 months. The treatment included a minimum of 3 week’s rehabilitation with the aim to retrain walking so that at least short distances could be covered after discharge from the rehabilitation centre [ 28 ]. After SDR, all eighteen children returned for post-op follow-up gait analysis, with an average follow-up of 8.6 (6–12) months postoperatively.…”

Section: Methodsmentioning

confidence: 99%

The Effects of Selective Dorsal Rhizotomy on Balance and Symmetry of Gait in Children with Cerebral Palsy

et al. 2016

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AimCerebral palsy (CP) is associated with dysfunction of the upper motor neuron and results in balance problems and asymmetry during locomotion. Selective dorsal rhizotomy (SDR) is a surgical procedure that results in reduced afferent neuromotor signals from the lower extremities with the aim of improving gait. Its influence on balance and symmetry has not been assessed. The aim of this prospective cohort study was to evaluate the impact of SDR on balance and symmetry during walking.Methods18 children (10 girls, 8 boys; age 6 years (y) 3 months (m), SD 1y 8m) with bilateral spastic CP and Gross Motor Function Classification System levels I to II underwent gait analysis before and 6 to 12 months after SDR. Results were compared to 11 typically developing children (TDC; 6 girls, 5 boys; age 6y 6m, SD 1y 11m). To analyse balance, sway velocity, radial displacement and frequency were calculated. Symmetry ratios were calculated for balance measures and spatio-temporal parameters during walking.ResultsMost spatio-temporal parameters of gait, as well as all parameters of balance, improved significantly after SDR. Preoperative values of symmetry did not vary considerably between CP and TDC group and significant postoperative improvement did not occur.InterpretationThe reduction of afferent signalling through SDR improves gait by reducing balance problems rather than enhancing movement symmetry.

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“…This could provide increased ease of daily life activities, such as dressing and self-hygiene. [ 7 9 11 16 ] However, clear postoperative expectations as well as patients’ preoperative functional conditions must first be evaluated. We have found that the postoperative functional improvements after SDR are comparable among pediatric and adult patients.…”

Section: Discussionmentioning

confidence: 99%

Selective dorsal rhizotomy for spastic diplegia secondary to stroke in an adult patient

2015

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Background:Selective dorsal rhizotomy (SDR) is often recommended for children with spastic paraparesis and cerebral palsy. SDR reduces spasticity in the lower extremities for these children with spastic paraplegia. However, SDR is infrequently recommended for adults with spasticity. Spastic diplegia in adult patients can be due to stroke, brain or spinal cord injury from trauma, infection, toxic-metabolic disorders, and other causes. Although rarely considered, SDR is an option for adult patients with spastic diplegia as well.Case Description:The authors describe a patient who underwent a SDR with a successful postoperative outcome. This man suffered a hypertensive and hemorrhagic stroke secondary to intravenous drug abuse at age 46. A SDR was performed after two failed intrathecal baclofen pump placements due to recurrent infections, likely resulting from his immunocompromised status. The patient underwent lumbar laminectomies and dorsal rhizotomies at levels L1-S1 bilaterally. Postoperatively, the patient's spasticity was significantly reduced. His Ashworth spasticity score decreased from 4/5 to 1/5, and the reduction in tone has been durable over 3 years.Conclusion:SDR in older patients with spastic paraparesis may be considered as a treatment option.

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Predictors for the benefit of selective dorsal rhizotomy

Cited by 28 publications

References 24 publications

Long‐term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case–control study

Long‐term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case–control study

The Effects of Selective Dorsal Rhizotomy on Balance and Symmetry of Gait in Children with Cerebral Palsy

Selective dorsal rhizotomy for spastic diplegia secondary to stroke in an adult patient

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