Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy

Steinbok, Paul; Hiçdönmez, Tufan; Sawatzky, Bonita; Beauchamp, Richard; Wickenheiser, Diane

doi:10.3171/ped.2005.102.4.0363

Cited by 46 publications

(56 citation statements)

References 39 publications

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“…Although idiopathic scoliosis is much more common in girls than boys [26], neuromuscular scoliosis does not discriminate between the genders. Children who have undergone selective dorsal rhizotomy for spasticity control seem to have a higher incidence of spinal deformity than those who have not undergone this procedure [27][28][29][30].…”

Section: Epidemiologymentioning

confidence: 99%

Musculoskeletal Complications of Neuromuscular Disease in Children

Driscoll

Skinner

2008

Physical Medicine and Rehabilitation Clinics of North America

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Section: Epidemiologymentioning

confidence: 99%

Musculoskeletal Complications of Neuromuscular Disease in Children

Driscoll

Skinner

2008

Physical Medicine and Rehabilitation Clinics of North America

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“…Given the effectiveness of SDR across different surgical techniques, the goal of surgical variation is to simplify surgical technique and reduce any possible morbidity. Prior variations in SDR technique utilizing multiple laminectomies to identify the nerve roots as they exit [14] continue to raise concern for possible contribution to spinal deformity after SDR [15]. The issue of spinal deformity after surgical intervention is somewhat contentious as it is well known that patients with CP are at higher risk of spinal deformity because of their underlying neuromuscular disease [16].…”

Section: Discussionmentioning

confidence: 99%

Infra-Conus Single-Level Laminectomy for Selective Dorsal Rhizotomy: Technical Advance

et al. 2016

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Background/Aims: Selective dorsal rhizotomy for spastic cerebral palsy is an effective and well-validated surgical approach. Multiple techniques have been described in the past including multiple laminectomies and a single-level laminectomy at the level of the conus. There is considerable technical challenge involved with a single-level laminectomy approach. Methods: We report here a modification of the single-level laminectomy that selectively analyzes each individual nerve root with electromyography to separate dorsal and ventral nerve roots through comparison of stimulus responses. Results: In 18 children with cerebral palsy who underwent this operation there was a mean improvement in the Modified Ashworth Scale of 2.0 with no reported incidence of muscle weakness, sensory loss, or neurogenic bladder. Conclusion: This approach allows for a modification of selective dorsal rhizotomy through a single-level laminectomy and tailors the selection of nerve root sectioning to the individual patient of interest while still maintaining its effectiveness.

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“…Stimulation of the dorsal roots was used to evaluate their degree of implication in the tone circuit excitability [6,11,12,22,33,42,43]. Dorsal root stimulation with all of its constituting rootlets as a whole was delivered in the form of 50-Hz trains, of 1 s each, at approximately 1 mA of intensity.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…The other is laminotomy limited to one to three level(s), exposing the conus medullaris/cauda equina at the thoracolumbar junction. The first mode requires longer postoperative immobilization and entails a higher risk of secondary instability and kyphosis [14,18,31,32,41,42,47,48]. With the second mode, which is at present the most popular and less invasive approach, especially if limited to a single level laminectomy/laminotomy, identification of root levels and corresponding functions-which may vary among individuals-is more difficult, and intraoperative electrostimulation less accurate [38].…”

Section: Introductionmentioning

confidence: 98%