Selective Dorsal Rhizotomy

Abbott, Rick; Johann-Murphy, Marjorie; Shiminski-Maher, Tania; Quartermain, David; Forem, Sandra L.; Gold, Joan; Epstein, Fred J.

doi:10.1227/00006123-199311000-00010

Cited by 59 publications

(8 citation statements)

References 27 publications

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“…Numerous studies have shown that, in children with spastic CP, SPR decreases lower limb spasticity, increases lower limb range of motion, and improves motor function [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. Most of these studies have involved relatively short follow-up times, usually about 1 year, and the longer term outcome is not as well documented.…”

Section: Discussionmentioning

confidence: 99%

“…Favorable outcomes after SPR have been demonstrated in numerous studies [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18], most of which have reported on early follow-up results. There have been few studies about the outcomes of SPR beyond 3 years [1, 12, 17, 19, 20], and of these studies, only rarely have quantitative outcome measures been used [20].…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome after Selective Posterior Rhizotomy in Children with Spastic Cerebral Palsy

1999

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A retrospective analysis of data collected prospectively was performed to determine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population comprised children with spastic CP, who had SPR more than 4 years prior to the time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically, muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the same measures. Hip adductor spasticity, hip abduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entry criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-year values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2.1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and quadriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed to be better at 1 and 5 years compared to baseline, but no statistical analysis was done for this secondary outcome measure. It was concluded that improvements in lower limb motor outcome are present at 1 year after SPR, and that these improvements are generally maintained at 5 years.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome after Selective Posterior Rhizotomy in Children with Spastic Cerebral Palsy

1999

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“…Park [31]followed 690 patients and encountered no weakness, CSF leak, meningitis or neurogenic bladder, but noted a small number of patients with bronchospasm, pneumonia or urinary tract infection. Other series have reported persistent neurogenic bladder in 14.4% [63]and 1.3% of patients [62], respectively.…”

Section: Complications Of Rhizotomymentioning

confidence: 99%

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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“…More intensified physiotherapy than is routinely available to children with spastic cerebral palsy has generally been used after SDR [9, 15, 16, 17, 18, 19]. The value of the post-SDR physiotherapy, the most appropriate intensity of the physiotherapy and what the physiotherapy should comprise are not known.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Motor Outcomes after Selective Dorsal Rhizotomy with and without Preoperative Intensified Physiotherapy in Children with Spastic Diplegic Cerebral Palsy

Steinbok

McLeod

2002

Pediatr Neurosurg

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A previous randomized clinical trial compared selective dorsal rhizotomy (SDR) plus postoperative intensified physiotherapy (group 1) with intensified physiotherapy alone (group 2) for children with spastic diplegic cerebral palsy. At the end of this trial, all patients in group 2 had an SDR, followed by further intensified physiotherapy. This study was performed to determine if the additional intensified physiotherapy before SDR, as occurred in group 2, improved long-term motor outcome. Outcomes were compared in the two groups, i.e. group 1 without intensified physiotherapy before SDR and group 2 with intensified physiotherapy before SDR. The primary outcome measure was the Gross Motor Function Measure (GMFM). Lower-limb spasticity, range and strength were secondary outcome measures. Baseline assessments had been done for the prior clinical trial. For this study, patients were reassessed by physiotherapists blinded to the treatment group. Thirteen children in each group were studied at a mean follow-up of 53 months. The mean improvement in GMFM was 10.0 in group 1 and 10.4 in group 2 (p = 0.9). Improvements in spasticity and range were similar in the two groups. There was no significant change in muscle strength in either group. It was concluded that in this relatively small series of patients, additional intensified physiotherapy before SDR did not improve motor outcomes.

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Selective Dorsal Rhizotomy

Cited by 59 publications

References 27 publications

Long-Term Outcome after Selective Posterior Rhizotomy in Children with Spastic Cerebral Palsy

Long-Term Outcome after Selective Posterior Rhizotomy in Children with Spastic Cerebral Palsy

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

Comparison of Motor Outcomes after Selective Dorsal Rhizotomy with and without Preoperative Intensified Physiotherapy in Children with Spastic Diplegic Cerebral Palsy

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