Spinal deformities following selective dorsal rhizotomy

Golan, Jeff D; Hall, Jeffery A.; O'Gorman, Gus; Poulin, Chantal; Benaroch, Thierry E.; Cantin, Marie-Andrée; Farmer, Jean‐Pierre

doi:10.3171/ped.2007.106.6.441

Cited by 42 publications

(66 citation statements)

References 45 publications

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“…However, there is conflicting evidence with respect to possible associations between the presence of pelvic obliquity and hip dislocation and the onset and progression of scoliosis [51]. In addition, some children undergoing selective dorsal rhizotomy appear to be at some risk for the development of scoliosis and other spinal deformities [30,50,41,101,103,109]. Similarly, there are conflicting reports regarding the use of intrathecal Baclofen and its effects on the progression of scoliosis [29,93,94,97].…”

Section: Spinementioning

confidence: 99%

Orthotic management of cerebral palsy: Recommendations from a consensus conference

Morris

Bowers

Ross

et al. 2011

NRE

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An international multidisciplinary group of healthcare professionals and researchers participated in a consensus conference on the management of cerebral palsy, convened by the International Society for Prosthetics and Orthotics. Participants reviewed the evidence and considered contemporary thinking on a range of treatment options including physical and occupational therapy, and medical, surgical and orthotic interventions. The quality of many of the reviewed papers was compromised by inadequate reporting and lack of transparency, in particular regarding the types of patients and the design of the interventions being evaluated. Substantial evidence suggests that ankle-foot orthoses (AFOs) that control the foot and ankle in stance and swing phases can improve gait efficiency in ambulant children (GMFCS levels I-III). By contrast, little high quality evidence exists to support the use of orthoses for the hip, spine or upper limb. Where the evidence for orthosis use was not compelling consensus was reached on recommendations for orthotic intervention. Subsequent group discussions identified recommendations for future research. The evidence to support using orthoses is generally limited by the brevity of follow-up periods in research studies; hence the extent to which orthoses may prevent deformities developing over time remains unclear. The full report of the conference can be accessed free of charge at www.ispoint.org.

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Section: Spinementioning

confidence: 99%

Orthotic management of cerebral palsy: Recommendations from a consensus conference

Morris

Bowers

Ross

et al. 2011

NRE

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“…8 We attribute this lower level of spinal deformity to the fact that we offer this surgery to ambulatory patients predominantly, that the laminotomy is purposefully narrow given that the stimulation and lesioning is performed on rootlets suspended outside the canal, and finally to the 3-point-perlevel fixation of the laminoplasty.…”

mentioning

confidence: 99%

Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy

Dudley

Parolin

Gagnon

et al. 2013

PED

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120

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Object Large-scale natural history studies of gross motor development have shown that children with spastic cerebral palsy (CP) plateau during childhood and actually decline through adolescence. Selective dorsal rhizotomy (SDR) is a well-recognized treatment for spastic CP, but little is known about long-term outcomes of this treatment. The purpose of this study was to assess the durability of functional outcomes in a large number of patients through adolescence and into early adulthood using standardized assessment tools. Methods The authors analyzed long-term follow-up data in children who had been evaluated by a multidisciplinary team preoperatively and at 1, 5, 10, and 15 years after SDR. These evaluations included quantitative, standardized assessments of lower-limb tone (Ashworth Scale), Gross Motor Function Measure (GMFM), and performance of activities of daily living (ADLs) by the Pediatric Evaluation of Disability Inventory in children who had been stratified by motor severity using the Gross Motor Function Classification System (GMFCS). In addition, group-based trajectory modeling (GBTM) was used to identify any heterogeneity of response to SDR among these treated children, and to find which pretreatment variables might be associated with this heterogeneity. Finally, a chart review of adjunct orthopedic procedures required by these children following SDR was performed. Results Of 102 patients who underwent preoperative evaluations, 97, 62, 57, and 14 patients completed postoperative assessments at 1, 5, 10, and 15 years, respectively. After SDR, through adolescence and into early adulthood, statistically significant durable improvements in lower-limb muscle tone, gross motor function, and performance of ADLs were found. When stratified by the GMFCS, long-lasting improvements for GMFCS Groups I, II, and III were found. The GBTM revealed 4 groups of patients who responded differently to SDR. This group assignment was associated with distribution of spasticity (diplegia was associated with better outcomes than triplegia or quadriplegia) and degree of hip adductor spasticity (Ashworth score < 3 was associated with better outcomes than a score of 3), but not with age, sex, degree of ankle plantar flexion spasticity, or degree of hamstring spasticity. In a sample of 88 patients who had complete records of orthopedic procedures and botulinum toxin (Botox) injections, 52 (59.1%) underwent SDR alone, 11 (12.5%) received only Botox injections in addition to SDR, while 25 patients (28.4%) needed further lower-extremity orthopedic surgery after SDR. Conclusions In the majority of patients, the benefits of SDR are durable through adolescence and into early adulthood. These benefits include improved muscle tone, gross motor function, and performance of ADLs, as well as a decreased need for adjunct orthopedic procedures or Botox injections. The children most likely to display these long-term benefits are those in GMFCS Groups I, II, and III, with spastic diplegia, less hip adductor spasticity, and preoperative GMFM scores greater than 60.

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“…Long-term influence on ICF activity and participation domains and risk of spinal anomalies after SDR remain uncertain. The level of evidence produced by these studies was poor to moderate with 18 Level IV studies [8][9][10][11][13][14][15][16][17][18][20][21][22][23][24][25][26] unable to evaluate causation and three Level III studies 12,19,27 able to provide tentative conclusions that the outcomes were attributable to the SDR.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…Six studies reported adverse events after a follow-up time of more than 5 years. 8,11,13,15,26,28 The follow-up times ranged from 5.8 to 21.4 years. All studies focused on the presence of spinal abnormalities and back pain.…”

Section: What Forms and Magnitudes Of Complications Have Been Documenmentioning

confidence: 99%

Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

Grunt

Becher

Vermeulen

2011

Developmental Medicine &Amp; Child Neurology

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Spinal deformities following selective dorsal rhizotomy

Abstract: There was a high rate of radiologically documented deformities in patients with CP who underwent SDR. Ambulatory function, CP severity, age at surgery, and sex may be contributing factors.

Cited by 42 publications

References 45 publications

Orthotic management of cerebral palsy: Recommendations from a consensus conference

Orthotic management of cerebral palsy: Recommendations from a consensus conference

Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy

Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

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