Predictors of poor outcome after selective dorsal rhizotomy in treatment of spastic cerebral palsy

Kim, Hyeon Sook; Steinbok, Paul; Wickenheiser, Diane

doi:10.1007/s00381-005-1160-2

Cited by 38 publications

(27 citation statements)

References 16 publications

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“…Poorer outcomes have been reported in children with spastic quadriplegia compared to those with spastic diplegia (16). Children over ten years of age have been reported to have better long-term outcomes with multilevel orthopedic surgery than with SDR (15).…”

Section: Outcome Of Sdrmentioning

confidence: 99%

“…Selection is typically based on clinical rationale rather than scientific evidence (14). While there is no restriction in age, evidence shows there is likely to be less benefit in patients with bilateral spastic CP undergoing SDR after the age of ten years (15) and patients with intellectual disability are likely to have a poorer prognosis (16). This raises the importance of quality selection algorithms for patients with bilateral spastic CP, the impact of which has been reported in a number of retrospective reviews (17)(18)(19).…”

Section: Patient Assessment For Sdrmentioning

confidence: 99%

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Single-level selective dorsal rhizotomy for spastic cerebral palsy

Graham¹,

Aquilina²,

Cawker³

et al. 2016

J. Spine Surg.

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The management of cerebral palsy (CP) is complex and requires a multidisciplinary approach. Selective dorsal rhizotomy (SDR) is a neurosurgical technique that aims to reduce spasticity in the lower limbs.A minimally invasive approach to SDR involves a single level laminectomy at the conus and utilises intraoperative electromyography (EMG). When combined with physiotherapy, SDR is effective in selected children and has minimal complications. This review discusses the epidemiology of CP and the management using SDR within an integrated multidisciplinary centre. Particular attention is given to the single-level laminectomy technique of SDR and its rationale, and the patient workup, recovery and outcomes of SDR.

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Section: Outcome Of Sdrmentioning

confidence: 99%

Section: Patient Assessment For Sdrmentioning

confidence: 99%

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Graham¹,

Aquilina²,

Cawker³

et al. 2016

J. Spine Surg.

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“…Among the changes in tonus, the most common is spasticity. Seventy-fi ve percent of children with CP have elevated tonus 1,8 , exacerbation of the tendinous refl exes and resistance to rapid, passive movement 6,9,10 . According to the topographical classifi cation, spastic children may be quadriplegic, diplegic, or hemiplegic 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Classificação da função motora e do desempenho funcional de crianças com paralisia cerebral

Chagas¹,

Defilipo²,

Lemos³

et al. 2008

Rev. bras. fisioter.

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“…Previously, authors of two investigations have attempted to predict postoperative outcomes based on preoperative data. 2, 16 Chicoine and colleagues 2 attempted to predict walking ability after SDR using a series of preoperative variables (subjective gait score, dorsiflexion ability, and diagnosis). The results of their multivariate regression analysis indicated that gait score and diagnosis (spastic diplegia or quadriplegia) had significant predictive capability, explaining 78% of the variance in predicting the postoperative gait score.…”

mentioning

confidence: 99%

“…Chicoine et al 2 attempted to predict a subjective assessment of walking ability by using diagnosis and a series of subjective measurements. Kim et al 16 attempted to predict poor or acceptable outcomes using diagnosis and a series of standard clinical evaluation measures. Another prediction path would be to use multidimensional objective measures of impairment and function 1 and only recruit patients with spastic diplegia to predict change in gait speed and function following SDR.…”

mentioning

confidence: 99%

Predicting functional change from preintervention measures in selective dorsal rhizotomy

Engsberg¹,

Ross²,

Collins³

et al. 2007

Journal of Neurosurgery: Pediatrics

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Object-In this investigation the authors attempted to predict change in function following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with spastic diplegic cerebral palsy (CP) based on multidomain preintervention measures.Methods-Data pertaining to 22 children with CP were collected before the SDR and again 20 months afterward. Although equations for predicting change in gait speed and function (such as the Gross Motor Function Measure) were derived, the 95% confidence interval (CI) widths were too broad to make accurate predictions that were clinically useful outside the study group.Conclusions-Future work should be focused on developing additional measures such as lowerextremity motor control and balance in an attempt to reduce the CIs to more clinically relevant values. Keywords cerebral palsy; gait spasticity; strength; rhizotomy; predictive measure; pediatric neurosurgery Selective dorsal rhizotomy is a surgical procedure used to treat patients with CP that involves partial sensory deafferentation at the L1-S2 levels. 22 The effectiveness of the surgery has been reported in randomized 19,28,30 and nonrandomized 8 clinical studies. Despite the evidence of its effectiveness, it is important to note that variability exists within the patient groups and not all patients exhibit the same degree of improvement from the SDR. For example, although in one patient in our investigation the GMFM score improved from 75% preoperatively to 86% at 20 months postoperatively (an 11-point improvement), the GMFM score in another patient changed from 73% preoperatively to 72% at 20 months postoperatively (a one-point decrease). 8 Relative to gait speed, one patient's speed improved from 61 cm/second preoperatively to 121 cm/second at 20 months postoperatively (a 60-cm/second improvement), whereas another patient's gait speed changed from 109 cm/second preoperatively to 102 cm/second at 20 months postoperatively (a 7-cm/second decrease).Being able to predict preoperatively which patients will have the greatest improvements in GMFM, gait speed, or some other outcome measure would be extremely valuable for them and Address reprint requests to: Jack R. Engsberg, Ph.D., Department of Physical Therapy, 3437 Caroline Street, Saint Louis University, St. Louis, Missouri 63104. email: E-mail: jengsber@slu.edu. their parents when considering the SDR. Previously, authors of two investigations have attempted to predict postoperative outcomes based on preoperative data. 2,16 Chicoine and colleagues 2 attempted to predict walking ability after SDR using a series of preoperative variables (subjective gait score, dorsiflexion ability, and diagnosis). The results of their multivariate regression analysis indicated that gait score and diagnosis (spastic diplegia or quadriplegia) had significant predictive capability, explaining 78% of the variance in predicting the postoperative gait score. Despite the large amount of explained variance in their patients, the investigators were hesitant to suggest that the...

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Predictors of poor outcome after selective dorsal rhizotomy in treatment of spastic cerebral palsy

Abstract: These data suggest that preoperative diagnosis is the strongest predictor of outcome after SDR. Intellectual delay demonstrated predictive power only in the univariate model, suggesting that it might have some prognostic value but less than the diagnosis.

Cited by 38 publications

References 16 publications

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Classificação da função motora e do desempenho funcional de crianças com paralisia cerebral

Predicting functional change from preintervention measures in selective dorsal rhizotomy

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