Selective Dorsal Rhizotomy in Children with Cerebral Palsy

Abstract

Objective: Effects of selective dorsal rhizotomy (SDR) were studied in children with spastic cerebral palsy in orthopaedic and functional fields. Methods: In a prospective study, we compared the same population before SDR and 1 year after SDR. This population included children with spastic cerebral palsy, when spasticity was responsible for a halt in the motor skill acquisitions or for orthopaedic complications. All the children had intensive physiotherapy for 6 months postoperatively. We observed spasticity by a 4-point scale, isolation of movement by a 3-point scale, and orthopaedic status by the measure of range of motion, hip migration on the radiography, and function by Gross Motor Function Measure (GMFM) and Abbott scale. All the assessments were done by the same physiotherapist. We compared the results with a Wilcoxon statistic test. Results: 18 quadriplegic children had spastic cerebral palsy; their mean age was 9 years (5.5–16.5 years). We observed a decrease in spasticity in all the muscular groups; increase in range of motion only on abduction and extension of the hips; no evolution of hip migration; an increase of 3.2% in the total GMFM score; 1 child was classified IV before SDR and V after SDR on the Abbott scale; 3 children had planned orthopaedic surgery in the year after SDR; 16 children and their families were highly satisfied with the result of the surgery. Conclusions: The decrease in spasticity does not entail prevention of orthopaedic problems in children with quadriplegic spastic cerebral palsy. However, we observed an improvement in qualitative function that is outside the scope of current assessment scales.

Prevention of hip displacement in children with cerebral palsy: a systematic review

“…Chan et al concluded that SDR had a neutral effect when 90% of those with preoperative hip subluxation continued to do so postoperatively, and 88% of those with typically developing hips preoperatively remained normal. Similarly, Hodgkinson et al reported no evolution of hip migration but that SDR did not have a preventative effect. A small case series reported rapid progression in five non‐ambulatory patients …”

“…Four non‐English language publications that addressed the study question were excluded. After full‐text review, 23 papers remained . A search of the reference lists of these articles and key articles on hip displacement identified one additional article (Greene et al).…”

A Review of Spasticity Treatments: Pharmacological and Interventional Approaches

“…It has shown significant reduction in spasticity in children, although the outcomes may be variable, and orthopedic complications, such as subluxation of the hips, may not be prevented. 47,48 A study by Oki et al 49 concluded that all the pediatric participants with spastic hemiparesis included in the study had a reduction of tone after SDR, as measured by a modified Ashworth scale, and showed an improvement in gait. Many adults who had SDR as children highly recommend the procedure as well.…”

Selection of treatment modalities in children with spastic cerebral palsy

“…77,81 There has been a trend toward relying less on the electrophysiological responses and more on the clinical findings, and in many centers a combination of the two is used. 37,[48][49][50]79,87 However, in only two of the three RCTs was the improvement in GMFM scores statistically more than in a control group receiving physiotherapy only. 74 There is very strong evidence that SDR results in improvements in lower-limb spasticity and an increase in the range of movement at the lower-limb joints with no loss of strength.…”

“…[35][36][37]59 The surgical procedure for SDR is performed either at the level of the conus via one-or two-level laminectomies, or at the level of the root exit foramina via multilevel laminectomies or laminotomies, with replacement of the laminar flap. With respect to this complication, fewer than 20% of patients worsened and the vast majority were stable (43-80%) or actually showed improvement (9-38%) in the amount of hip subluxation after SDR.…”