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

Eppinger, Melissa Ann; Berman, Casey Melissa; Mazzola, Catherine A.

doi:10.4103/2152-7806.159382

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…No change in tone post-SDR was reported in 24.6% (n = 35). Six of 12 publications documented changes in spasticity using the modified Ashworth score (MAS) [8][9][10][11][12][13]. Analysis of adult patients in these publications showed that SDR led to marked reduction in the spasticity of the hip flexors, hip adductors, hamstrings, quadriceps, and gastrocnemius/soleus muscles (Table 3).…”

Section: Efficacy Of Sdr On Managing Spasticity/tonementioning

confidence: 99%

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Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

Kakodkar

Fallah

2021

Childs Nerv Syst

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Purpose Selective dorsal rhizotomy (SDR) has been used to improve mobility and reduce lower extremity spasticity in patients with a various CNS conditions. Incidentally, literature on SDR has been performed in the pediatric population as such there is a paucity of research on the use in adult patients. Methods Studies describing SDR in adults were identified from Medline and Embase databases. Combinations of search terms "Selective Dorsal Rhizotomy," "Selective Posterior Rhizotomy," and "Adult" were used. Only literature in English language on patients over the age of 18 years and that included measures for lower extremity outcome (i.e., spasticity, mobility) were included. Case reports, reviews without primary data, or inaccessible publications were excluded. Results One hundred twenty-nine publications between 1970 and 2019 were identified. Twelve of these publications fit the inclusion criteria (n = 141 patients). In series where it was reported, SDR resulted in ambulatory improvement (54%, n = 44 out of 81), reduced spasticity (75.2%, n = 106 out of 141), and minimized muscle and joint pain (74.5%, n = 64 out of 86). SDR also showed improvement in parameters of the activities of daily life. 92.3% (n = 48 out of 52) of patients post-SDR developed new lower limb paresthesia. Conclusion The success and efficacy appear durable in the short-term, but further follow-up is necessary to validate these findings. The goal of the intervention dictates the ideal adult patient for SDR. Patients seeking ambulatory improvement, any etiology of spasticity besides MS, seem favorable. Positive locomotive predictors include the ability to isolate lower extremity function, lack of contractures, lower limb strength, and post-SDR physiotherapy.

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Section: Efficacy Of Sdr On Managing Spasticity/tonementioning

confidence: 99%

“…The pain profile before and after SDR was recorded in 7 publications (n = 86) [9,10,[12][13][14][15][16]. After SDR, lower limb muscle and joint pain was completely eliminated in 4.7% (n = 4).…”

Section: Pain and Sensory Deficitmentioning

confidence: 99%

Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

Kakodkar

Fallah

2021

Childs Nerv Syst

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“…Eppinger et al [51] describe a patient who suffered from hypertension and a hemorrhagic stroke at the age of 46 who underwent SDR (L1-S1). The surgery was performed after two failed intrathecal baclofen pump placements due to repeated infections.…”

Section: Secondary Lower Extremity Spasticitymentioning

confidence: 99%

The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR)

Sun

Huang

Deng

et al. 2020

Brain Science Advances

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Spasticity is the main disabling clinical manifestation of children with cerebral palsy (CP). Selective dorsal rhizotomy (SDR) has been performed for the treatment of spastic CP in Asia for quite some time from 1990. The purpose of this review is to discuss the historical origin and development of SDR. Our goal here is to identify the current patient selection criteria for SDR and to point out indications and contraindications based on the patients with CP, age from 2 to 18 years-old, over 6000 cases, who received SDR surgery with spasticity of muscle tension more than 3 degrees in our center. We also discuss evidence-based approaches on how to evaluate postoperative patient outcomes of SDR and how complications can be avoided. Finally, we mention progress made in terms of SDR technical advances and how improvements can be made in the future. In conclusion, SDR surgery is a reliable way to improve outcomes of patients with spastic CP and can be done carefully in patients as long as stringent selection criteria are used. However, more research and technological advancements are needed to help address associated complications.

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“…The study by Chan et al mentioned a participant with hereditary spastic paraparesis (HSP), in addition to 20 individuals with CP. 7 Although CP diagnosis was one of the inclusion criteria of this review, SDR can also be indicated for patients with spasticity resulting from other diagnoses such as multiple sclerosis, Leigh syndrome, 25 stroke, 26 spinal cord injury 24 , and transverse myelitis. 27 …”

Section: Data Synthesismentioning

confidence: 99%

Rizotomia Dorsal Seletiva Na Paralisia Cerebral: Critérios De Indicação E Protocolos De Reabilitação Fisioterapêutica Pós-Operatória

Nicolini‐Panisson

Tedesco²,

Folle³

et al. 2018

Rev. paul. pediatr.

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Objective: To identify selection criteria for selective dorsal rhizotomy (SDR) in cerebral palsy, to analyze the instruments used for evaluation, and to describe the characteristics of physical therapy in postoperative protocols.Data sources: Integrative review performed in the following databases: SciELO, PEDro, Cochrane Library, and PubMed. The terms in both Portuguese and English for “cerebral palsy”, “selective dorsal rhizotomy”, and “physical therapy” were used in the search. Studies whose samples enrolled individuals with cerebral palsy who had attended physical therapy sessions for selective dorsal rhizotomy according to protocols and describing such protocols’ characteristics were included. Literature reviews were excluded and there was no restriction as to period of publication.Data synthesis: Eighteen papers were selected, most of them being prospective cohort studies with eight-month to ten-year follow-ups. In most studies, the instruments of assessment encompassed the domains of functions, body structure, and activity. The percentage of posterior root sections was close to 50%. Primary indications for SDR included ambulatory spastic diplegia, presence of spasticity that interfered with mobility, good strength of lower limbs and trunk muscles, no musculoskeletal deformities, dystonia, ataxia or athetosis, and good cognitive function. Postoperative physical therapy is part of SDR treatment protocols and should be intensive and specific, being given special emphasis in the first year.Conclusions: The studies underline the importance of appropriate patient selection to obatin success in the SDR. Postoperative physical therapy should be intensive and long-term, and must necessarily include strategies to modify the patient’s former motor pattern.

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

Cited by 8 publications

References 21 publications

Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR)

Rizotomia Dorsal Seletiva Na Paralisia Cerebral: Critérios De Indicação E Protocolos De Reabilitação Fisioterapêutica Pós-Operatória

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