Short-term change of tibial torsion in children with spastic cerebral palsy after selective dorsal rhizotomy

Abstract

Background Spastic cerebral palsy (CP) is a prevalent cause of motor dysfunction in children, with patients often experiencing secondary musculoskeletal deformities, including tibial torsion. This study aimed to investigate the short-term effect of selective dorsal rhizotomy (SDR) on tibial torsion in children with spastic CP. Methods We conducted a retrospective review of children with spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children’s Hospital, between July 2019 and November 2022. Pre- and post-operative physical assessments were examined. Results A total of 148 children were included in the study. After SDR, there was a significant decrease in muscle tone in the lower limb muscle groups. Joint range of motion in the lower limbs also increased post-surgery. Bilateral transmalleolar angle (TMA) showed a significant increase after the surgery, and 21% limbs classified as internal tibial torsion before SDR changed into normal angle post-operatively. Limbs with better improvement after SDR derived from younger patients and had lower muscle tone in the hamstring muscles when compared to those that did not show improvement. Conclusions SDR has the potential to increase TMA in children with spastic CP. Limbs classified as internal tibial torsion are more likely to improve after SDR if they have lower muscle tone in the hamstring muscles and are derived from younger patients.

Before selective dorsal rhizotomy can be judged as beneficial for cerebral palsy, long-term results and controlled studies are needed

“…We read with interest Wang et al ’s article about a retrospective study of 143 pediatric patients with cerebral palsy who underwent selective dorsal rhizotomy (SDR) between July 2019, and November 2022 and were examined pre- and post-operatively ( 1 ). It was found that SDR significantly reduced the muscle tone of the lower limb muscle groups, the range of motion of the joints in the lower limbs and the transmalleolar angle (TMA) increased after surgery, and the preoperative internal tibial torsion before SDR decreased and changed to a normal angle post-operatively in 21% of limbs ( 1 ). Improvement with SDR was observed particularly in younger patients with low muscle tone in the hamstring muscles ( 1 ).…”

“…It was found that SDR significantly reduced the muscle tone of the lower limb muscle groups, the range of motion of the joints in the lower limbs and the transmalleolar angle (TMA) increased after surgery, and the preoperative internal tibial torsion before SDR decreased and changed to a normal angle post-operatively in 21% of limbs ( 1 ). Improvement with SDR was observed particularly in younger patients with low muscle tone in the hamstring muscles ( 1 ). It was concluded that SDR has the potential to increase TMA in cerebral palsy patients and that anterior tibial torsion improves after SDR especially when patients are young and have low muscle tone in the hamstring muscles ( 1 ).…”

“…Improvement with SDR was observed particularly in younger patients with low muscle tone in the hamstring muscles ( 1 ). It was concluded that SDR has the potential to increase TMA in cerebral palsy patients and that anterior tibial torsion improves after SDR especially when patients are young and have low muscle tone in the hamstring muscles ( 1 ). The study is excellent but some points need discussion.…”

“…We should therefore know how many of the 148 patients included suffered from contractures. In particular, an explanation should be provided how the joint range of motion in the lower limbs increased after surgery in patients with contractures, how the TMA could increase after SDR, and how internal tibial torsion before SDR could change to a normal angle in 21% of limbs postoperatively ( 1 ).…”

Enhancing understanding and optimizing outcomes: insights from selective dorsal rhizotomy in pediatric cerebral palsy

“…We would like to extend our gratitude to Dr. Walter Strobl and colleagues for their thoughtful and constructive critique of our recent clinical study titled “Short-term change of tibial torsion in children with spastic cerebral palsy after selective dorsal rhizotomy”, which was published in the Translational Pediatrics ( 1 ).…”