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Duc Lien N, Van Linh N, Cam Van NT, Giang LT, King DT, Tarren A, Dat ND, Rocque BG. Selective Dorsal Rhizotomy for Spastic Cerebral Palsy: Report of 18 Cases Performed in the North of Vietnam. World Neurosurg 2024; 188:e128-e133. [PMID: 38762026 DOI: 10.1016/j.wneu.2024.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE The purpose of this report is to describe a case series of children undergoing selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy in Vietnam. Also described is an international cooperation model to facilitate the development of a new, multidisciplinary team for the evaluation and treatment of these children. METHODS Details of international collaboration are described, including in-person travel and virtual interactions. All cases of children younger than 18 years undergoing SDR for treatment of spastic cerebral palsy at a single center in Hanoi, Vietnam are described, including preoperative evaluation of spasticity and gait as well as results at 6 and 12 months. Results are summarized using descriptive statistics. RESULTS Since the beginning of cooperation in training and transferring SDR techniques by experts from the United States, in the period from June 2016 to December 2022, 18 SDR surgeries were performed in Hanoi. Patients' ages ranged from 2 to 14 years; 13 were male and 5 were female. Overall, approximately 60% of nerve rootlets were cut. Modified Ashworth Scale scores at 6 and 12 months after surgery in the hip, knee, and ankle joints showed improvement from preoperative values. There were 2 recorded complications: intracranial hypotension causing subdural hemorrhage and a case of skin infection at the incision site. CONCLUSIONS The ongoing international cooperation between Vietnamese and American physicians has helped improve the surgical treatment of spasticity in children with cerebral palsy in Hanoi, providing children with a surgical treatment option with successful outcomes.
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Affiliation(s)
- Nguyen Duc Lien
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam.
| | - Nguyen Van Linh
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam
| | - Nguyen Thi Cam Van
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam
| | - Le Thi Giang
- Department of Neurosurgery, Vietnam National Cancer Hospital, Hanoi, Vietnam; National Children Hospital, Hanoi, Vietnam
| | | | - Anna Tarren
- Children's of Alabama, Birmingham, Alabama, USA
| | | | - Brandon G Rocque
- Children's of Alabama, Birmingham, Alabama, USA; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
PURPOSE To review the neurosurgical treatments of children with movement disorders associated with cerebral palsy (CP) during the previous decades, up to the present day. METHODS An extensive literature review was undertaken to identify important publications about this subject. My experience treating children with these disorders over the past three decades was included in the individual sections. RESULTS Peripheral neurotomies have been developed for children with focal spasticity. For those with spastic paraparesis, selective lumbar rhizotomies were developed, and for those with spastic quadriparesis, intrathecal baclofen infusions were developed. Both effectively alleviate spasticity in the affected extremities. Generalized dystonia associated with CP has been treated with deep brain stimulation with mild improvement, but treatment with intrathecal baclofen and intraventricular baclofen improve those movements markedly. No effective treatment has been reported for children with athetoid CP. For those with choreiform CP, deep brain stimulation may be effective but intrathecal baclofen does not appear to be. CONCLUSION Treatment of children with movement disorders associated with CP increased slowly in the 1970s and 1980s but accelerated rapidly in the 1990s with the introduction of lumbar dorsal rhizotomies and intrathecal baclofen. In the last 30 years, tens of thousands of children with spasticity and movement disorders associated with CP have been treated by pediatric neurosurgeons, and their care has become an integral component of current pediatric neurosurgical practice.
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Shahid J, Kashif A, Shahid MK. Enhancing Post-Operative Recovery in Spastic Diplegia through Physical Therapy Rehabilitation following Selective Dorsal Rhizotomy: A Case Report and Thorough Literature Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050842. [PMID: 37238390 DOI: 10.3390/children10050842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Spasticity is a common issue among children, especially those with bilateral spastic cerebral palsy (CP). Selective dorsal rhizotomy (SDR) is a surgical procedure that is often used to decrease lower limb rigidity, alongside other treatment options such as intrathecal medication, peripheral nerve surgery, and deep brain stimulation (DBS). The objective of these therapies is to improve the standard of living for young individuals. This article intends to explain the motor deficits observed in spastic diplegia and a rehabilitation program using physical therapy after SDR. The information can help with counseling parents about the prognosis and developing a clinical treatment plan. The article presents a case study of a 12-year-old girl who recently underwent L3, L4, and L5 nerve root rhizotomy in the physical therapy department. It highlights the importance of long-term physical therapy follow-up and orthotic usage in the management of spastic diplegia.
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Affiliation(s)
- Jawaria Shahid
- Department of Physical Therapy, Ikram Hospital, Gujrat 50700, Pakistan
- Center of Physical Therapy, Rayan Medical Center, Gujrat 50700, Pakistan
| | - Ayesha Kashif
- Department of Senior Health Care, Eulji University, Uijeongbu-si 11759, Republic of Korea
| | - Muhammad Kashif Shahid
- Research Institute of Environment & Biosystem, Chungnam National University, Daejeon 34134, Republic of Korea
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Dekopov AV, Tomsky AA, Isagulyan ED. [Methods and results of neurosurgical treatment of cerebral palsy]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:106-112. [PMID: 37325833 DOI: 10.17116/neiro202387031106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Treatment of spastic syndrome and muscular dystonia in patients with cerebral palsy is a complex clinical problem. Effectiveness of conservative treatment is not high enough. Modern neurosurgical techniques for spastic syndrome and dystonia are divided into destructive interventions and surgical neuromodulation. Their effectiveness is different and depends on the form of disease, severity of motor disorders and age of patients. OBJECTIVE To evaluate the effectiveness of various methods of neurosurgical treatment of spasticity and muscular dystonia in patients with cerebral palsy. MATERIAL AND METHODS We To evaluate the effectiveness of various methods of neurosurgical treatment of spasticity and muscular dystonia in patients with cerebral palsy.analyzed literature data in the PubMed database using the keywords «cerebral palsy», «spasticity», «dystonia», «selective dorsal rhizotomy», «selective neurotomy», «intrathecal baclofen therapy», «spinal cord stimulation», «deep brain stimulation». RESULTS Effectiveness of neurosurgery was higher for spastic forms of cerebral palsy compared to secondary muscular dystonia. Destructive procedures were the most effective among neurosurgical operations for spastic forms. Effectiveness of chronic intrathecal baclofen therapy decreases in follow-up due to secondary drug resistance. Destructive stereotaxic interventions and deep brain stimulation are used for secondary muscular dystonia. Effectiveness of these procedures is low. CONCLUSION Neurosurgical methods can partially reduce severity of motor disorders and expand the possibilities of rehabilitation in patients with cerebral palsy.
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Affiliation(s)
- A V Dekopov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A A Tomsky
- Burdenko Neurosurgical Center, Moscow, Russia
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Veerbeek BE, Lamberts RP, Kosel E, Fieggen AG, Langerak NG. More than 25 years after selective dorsal rhizotomy: physical status, quality of life, and levels of anxiety and depression in adults with cerebral palsy. J Neurosurg 2021; 136:689-698. [PMID: 34507281 DOI: 10.3171/2021.3.jns204096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary purpose of selective dorsal rhizotomy (SDR) is to ameliorate spasticity in the lower extremities of children with cerebral palsy (CP). In correctly selected patients, this neurosurgical procedure has been shown to have a beneficial effect on many aspects of the child's life. However, given the challenges faced by adults with CP, it would be valuable to document the status of this population compared to their peers later in adulthood. Therefore, the aim of this study was to determine the physical status, mental health, and health-related quality of life (HRQoL) of adults with CP who underwent SDR at least 25 years ago, compared to matched typically developing (TD) individuals. The second aim was to investigate relationships between physical status and the other outcome measures. METHODS Adults with CP were recruited from a database of children who had undergone SDR performed using the technique introduced by Professor Warwick Peacock at Red Cross War Memorial Children's Hospital in Cape Town, South Africa, between 1981 and 1991. These individuals were matched for age, sex, body mass index, and socioeconomic status to a TD adult cohort from a similar background. The parameters assessed were lower-extremity muscle tone, passive range of motion, muscle strength, selectivity, functional mobility and dynamic balance (Timed Up and Go [TUG] test), HRQoL (SF-36), and anxiety and depression levels. RESULTS Twenty-six adults with CP who had a median age of 35.8 years (interquartile range 34.2-41.4 years) (female/male: n = 10/16; Gross Motor Function Classification System level I/II/III: n = 13/10/3), were compared to 26 TD adults. Muscle tone was similar, whereas passive range of motion, muscle strength, selectivity, TUG, and SF-36 physical functioning (concept and summary) scores differed between the cohorts. Other SF-36 parameters, anxiety levels, and depression levels were not different. Strong correlations were found between the muscle strength and TUG scores. CONCLUSIONS Normalized lower-extremity muscle tone was sustained 25-35 years after SDR. Whereas the lower scores for physical assessments are in line with findings in other CP populations, remarkably, relatively good mental health and HRQoL scores were reported in this CP group despite their physical limitations. The strong correlation between muscle strength and TUG suggests that strength training after SDR may have value in improving functional mobility and balance.
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Affiliation(s)
- Berendina E Veerbeek
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Robert P Lamberts
- 2Department of Sport Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; and
| | - Elisa Kosel
- 3Department of Biomechanics in Sports, Technical University of Munich, Germany
| | - A Graham Fieggen
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Nelleke G Langerak
- 1Neuroscience Institute and Division of Neurosurgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa
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Intrathecal baclofen, selective dorsal rhizotomy, and extracorporeal shockwave therapy for the treatment of spasticity in cerebral palsy: a systematic review. Neurosurg Rev 2021; 44:3209-3228. [PMID: 33871733 DOI: 10.1007/s10143-021-01550-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Cerebral palsy (CP) is a chronic congenital disorder as the result of abnormal brain development. Children suffering from CP often battle debilitating chronic spasticity, which has been the focus of recent academic literature. In this systematic review, the authors aim to update the current neuromodulation procedures for the treatment of spasticity associated with CP in all age groups. A systematic review following was conducted using PubMed from inception to 2020. After initial title and abstract screening, 489 articles were identified, and 48 studies met the inclusion criteria for this review. In total, a majority of the published articles of treatments for CP were reporting the use of selective dorsal rhizotomy (SDR) (54%), and the remainder were of intrathecal baclofen (ITB) pumps (29%) and extracorporeal shockwave therapy (ESWT) (17%). Each method was found to have improvement of spasticity at a rate that achieved statistical significance. ITB pump therapy is an all-encompassing method of treating spasticity in children from CP, as it allows for a less invasive treatment that can be titrated to individual patient needs; however, its disadvantages include its long-term maintenance requirements. SDR appears to be an effective method for permanent spasticity relief in young patients. ESWT is a more recent and innovative technique for offering relief of spasticity while being minimally invasiveness. Further studies are needed to establish optimal frequencies and sites of application for ESWT.
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Gillespie CS, George AM, Hall B, Toh S, Islim AI, Hennigan D, Alder Hey Physiotherapy Group, Kumar R, Pettorini B. The effect of GMFCS level, age, sex, and dystonia on multi-dimensional outcomes after selective dorsal rhizotomy: prospective observational study. Childs Nerv Syst 2021; 37:1729-1740. [PMID: 33599808 PMCID: PMC8084767 DOI: 10.1007/s00381-021-05076-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE Investigate the effect of age category (1-9 years vs 10-18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR). METHODS Prospective, single-center study of all children aged 3-18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes. RESULTS From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05-7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively). CONCLUSION SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.
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Affiliation(s)
- Conor Scott Gillespie
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK. .,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK.
| | - Alan Matthew George
- grid.417858.70000 0004 0421 1374Present Address: Department of Neurosurgery, Alder Hey Children’s Hospital NHS Trust, Liverpool, UK ,grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin Hall
- grid.452080.b0000 0000 8948 3192Aintree University Hospitals NHS Foundation Trust, Liverpool, UK ,grid.10025.360000 0004 1936 8470School of Medicine, University of Liverpool, Liverpool, UK
| | - Steven Toh
- grid.10025.360000 0004 1936 8470School of Medicine, University of Liverpool, Liverpool, UK
| | - Abdurrahman Ismail Islim
- grid.10025.360000 0004 1936 8470School of Medicine, University of Liverpool, Liverpool, UK ,grid.269741.f0000 0004 0421 1585Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Dawn Hennigan
- grid.417858.70000 0004 0421 1374Present Address: Department of Neurosurgery, Alder Hey Children’s Hospital NHS Trust, Liverpool, UK
| | | | - Ram Kumar
- grid.417858.70000 0004 0421 1374Present Address: Department of Neurosurgery, Alder Hey Children’s Hospital NHS Trust, Liverpool, UK
| | - Benedetta Pettorini
- grid.417858.70000 0004 0421 1374Present Address: Department of Neurosurgery, Alder Hey Children’s Hospital NHS Trust, Liverpool, UK
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Tu A, Steinbok P. Long term outcome of Selective Dorsal Rhizotomy for the management of childhood spasticity-functional improvement and complications. Childs Nerv Syst 2020; 36:1985-1994. [PMID: 32577879 DOI: 10.1007/s00381-020-04747-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) for the management of lower extremity spasticity is a surgical technique that has existed since the 1900s. While much evidence supports its efficaciousness in reducing tone in the short term, limited information exists detailing the long-term outcome and evolution over time of patients undergoing SDR. METHODS All publications with 10 years or more of outcome data on patients undergoing SDR were identified from Medline and Embase databases using the search term "Rhizotmy." Only publications that were in English included patients with cerebral palsy under the age of 21 and discussed SDR for lower extremity spasticity were included. Case reports, reviews without primary data, or publications not accessible online were excluded from the review. RESULTS A total of 2128 publications were initially identified, of which 19 papers describing 1054 patients fit inclusion and exclusion criteria. GMFCS in most patients improved or remained stable over time after surgery, although durability of improvement and final outcome was dependent on initial functional status. Tone was noted to also substantially improve although a small proportion required additional oral or injectable pharmacologic agents and an even smaller proportion required baclofen pumps. Upper extremity function was also noted to improve substantially after SDR. A significant number of patients were independent for activities of daily living and were engaged in secondary education or gainful employment. A significant proportion of patients still required orthopedic surgery to the lower extremities after SDR, although the incidence of spinal deformity was not observed to be substantially elevated over that of natural history. CONCLUSION SDR offers substantial improvements to a number of domains beyond pure tone reduction. These changes are durable over time, although patient selection is crucial in identifying those patients that will have the most benefit. Long-term follow-up is in important in this population given the potential need for further interventions that still exist in many patients.
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Affiliation(s)
- Albert Tu
- Division of Pediatric Neurosurgery, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L, Canada.
| | - Paul Steinbok
- Division of Pediatric Neurosurgery, Children's Hospital of British Columbia, Vancouver, Canada
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Tedroff K, Hägglund G, Miller F. Long-term effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2020; 62:554-562. [PMID: 31342516 PMCID: PMC7187377 DOI: 10.1111/dmcn.14320] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the long-term effects of selective dorsal rhizotomy (SDR) 10 years or more after the procedure and complications observed any time after SDR in children with cerebral palsy (CP). METHOD Embase, PubMed, and the Cochrane Library were searched from their individual dates of inception through 1st June 2018 for full-text original articles in English that described long-term follow-up after SDR in children with CP. The authors independently screened publications to determine whether they met inclusion criteria; thereafter all authors extracted data on patient characteristics, the proportion of the original cohort being followed-up, and the reported outcomes. RESULTS Of the 199 studies identified, 16 were included in this evaluation: 14 were case series and two studies reported a retrospectively assigned comparison group. Evidence concerning function was limited by study design differences, clinical variability, loss to follow-up, and heterogeneity across trials. INTERPRETATION At 10 years or more follow-up, available studies generate low-level evidence with considerable bias. No functional improvement of SDR over routine therapy is documented. Furthermore, the long-term effects of SDR with respect to spasticity reduction is unclear, with many studies reporting a high amount of add-on spasticity treatment. More long-term follow-up using robust scientific protocols is required before it can be decided whether the use of SDR as routine therapy for children with CP is to be recommended or not. WHAT THIS PAPER ADDS Ten years after selective dorsal rhizotomy, available studies supply inconclusive evidence on functional outcomes. The long-term effect on spasticity is uncertain, studies reported a substantial need for add-on treatment. Short- and long-term complications seem frequent but are not reported in a consistent manner.
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Affiliation(s)
- Kristina Tedroff
- Neuropaediatric Unit, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Gunnar Hägglund
- Department of Clinical Sciences Lund, OrthopaedicsLund UniversityLundSweden
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Ates F, Brandenburg JE, Kaufman KR. Effects of Selective Dorsal Rhizotomy on Ankle Joint Function in Patients With Cerebral Palsy. Front Pediatr 2020; 8:75. [PMID: 32185154 PMCID: PMC7058800 DOI: 10.3389/fped.2020.00075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
Selective dorsal rhizotomy (SDR) is a neurosurgical technique performed to reduce muscle spasticity and improve motor functions in children with cerebral palsy (CP). In long term, muscle contractures were observed even after SDR. To better understand what is contributing to contracture formation, it is necessary to assess the effects of SDR on joint stiffness. We hypothesized that ankle passive range of motion (ROM) increases and the quasi-stiffness of the ankle joint decreases after SDR in children with CP. This retrospective study included 10 children with diplegic CP (median age 6 years 2 months) who had undergone SDR and for whom gait analysis data were collected 3 months before (Pre-SDR) and 13 months after (Post-SDR) surgery. Additional to clinical measures, ankle quasi-stiffness (the slope of the ankle moment vs. ankle angle plot) was analyzed from gait data. Passive ankle ROM at 0° (p < 0.0001) and 90° knee angles (p < 0.0001) increased after SDR. Dynamic EMG analysis showed improved phasic gastrocnemius activity (p < 0.0001). Equinus gait was improved with the reduction of peak plantar flexion (p < 0.0001), as well as an increase in peak dorsiflexion (p = 0.006) during walking was observed. Ankle joint quasi-stiffness (Pre- and post-SDR median = 0.056 Nm/kg/° and 0.051 Nm/kg/°, and interquartile range: 0.031 Nm/kg/° and 0.019 Nm/kg/°, respectively) decreased significantly (p = 0.0017) after SDR. Moreover, even though the total time of the gait cycle did not change (p = 0.99), the time interval from maximum dorsiflexion to maximum plantar flexion (Pre- and post-SDR median = 0.125 s and 0.156 s, and interquartile range: 0.153 and 0.253 s, respectively) increased significantly (p = 0.0068) after SDR. In conclusion, the decreased ankle quasi-stiffness and the enhanced time interval in the gait cycle due to SDR indicate better motor control and joint stability. Our findings suggest that the long-term contracture formation occurring even after surgical interventions may be related to the stiffening of non-contractile structures.
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Affiliation(s)
- Filiz Ates
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States.,Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
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Frequency distribution in intraoperative stimulation-evoked EMG responses during selective dorsal rhizotomy in children with cerebral palsy-part 1: clinical setting and neurophysiological procedure. Childs Nerv Syst 2020; 36:1945-1954. [PMID: 32577878 PMCID: PMC7434802 DOI: 10.1007/s00381-020-04734-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Selective dorsal rhizotomy (SDR) consists of microsurgical partial deafferentation of sensory nerve roots (L1-S2). It is primarily used today in decreasing spasticity in young cerebral palsy (CP) patients. Intraoperative monitoring (IOM) is an essential part of the surgical decision-making process, aimed at improving functional results. The role played by SDR-IOM is examined, while realizing that connections between complex EMG responses to nerve-root stimulation and a patient's individual motor ability remain to be clarified. METHODS We conducted this retrospective study, analyzing EMG responses in 146 patients evoked by dorsal-root and rootlet stimulation, applying an objective response-classification system, and investigating the prevalence and distribution of the assessed grades. Part1 describes the clinical setting and SDR procedure, reintroduced in Germany by the senior author in 2007. RESULTS Stimulation-evoked EMG response patterns revealed significant differences along the segmental levels. More specifically, a comparison of grade 3+4 prevalence showed that higher-graded rootlets were more noticeable at lower nerve root levels (L5, S1), resulting in a typical rostro-caudal anatomical distribution. CONCLUSIONS In view of its prophylactic potential, SDR should be carried out at an early stage in all CP patients suffering from severe spasticity. It is particularly effective when used as an integral part of a coordinated, comprehensive spasticity program in which a team of experts pool their information. The IOM findings pertaining to the anatomical grouping of grades could be of potential importance in adjusting the SDR-IOM intervention to suit the specific individual constellation, pending further validation. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03079362.
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Veerbeek BE, Lamberts RP, Fieggen AG, Verkoeijen PPJL, Langerak NG. Daily activities, participation, satisfaction, and functional mobility of adults with cerebral palsy more than 25 years after selective dorsal rhizotomy: a long-term follow-up during adulthood. Disabil Rehabil 2019; 43:2191-2199. [PMID: 31815556 DOI: 10.1080/09638288.2019.1695001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To determine changes in level of accomplishment and satisfaction in daily activities and social participation, and functional mobility in adults with cerebral palsy (CP) more than 25 years after selective dorsal rhizotomy (SDR). MATERIALS AND METHODS This long-term observational nine-year follow-up study included 26 adults (median age 35 years) with CP and spastic diplegia, and 26 matched typically developing adults. Assessment tools used were the Life-Habits questionnaire and the Functional Mobility Scale. RESULTS Most of the adults with CP were independent and satisfied with accomplishing life habits and no changes were determined, except for a small change in the Housing accomplishment level. Compared to typically developing adults, the CP cohort was more dependent in accomplishing Mobility and Recreation. However, the level of satisfaction was similar for most life habits except for Mobility. Functional mobility did not change, but correlated with Life-Habits results. CONCLUSIONS Adults with CP showed high and stable levels of accomplishment and satisfaction in daily activities and social participation more than 25 years after SDR. This is in contrast with the literature, where functional decline was shown for individuals with CP as they age. The relation with functional mobility highlights the importance to focus the rehabilitation on maintaining walking ability in order to enable high level of daily activities and social participation in adults with CP.Implications for rehabilitationSelective dorsal rhizotomy (SDR) is a valuable treatment option for a selective group of children with cerebral palsy (CP) in order to reduce spasticity.The long-term outcomes of SDR on level of accomplishment and satisfaction in daily activities and social participation as well functional mobility in adults with CP are not clear.More than 25 years after SDR adults with CP experienced stable and lasting high levels of functioning regarding daily activities and social participation and were satisfied with the way they accomplished life habits.Functional mobility was correlated to level of accomplishment and satisfaction in daily activities and social participation, which highlights the importance to focus rehabilitation programs on maintaining functional mobility in order to enable daily activities and social participation in adults with CP.
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Affiliation(s)
- Berendina E Veerbeek
- Department of Surgery, Faculty of Health Sciences, Neuroscience Institute and Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Robert P Lamberts
- Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University, Tygerberg, South Africa
| | - A Graham Fieggen
- Department of Surgery, Faculty of Health Sciences, Neuroscience Institute and Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Peter P J L Verkoeijen
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Learning and Innovation Center, Avans University of Applied Sciences, Breda, The Netherlands
| | - Nelleke G Langerak
- Department of Surgery, Faculty of Health Sciences, Neuroscience Institute and Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
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Iorio-Morin C, Yap R, Dudley RWR, Poulin C, Cantin MA, Benaroch TE, Farmer JP. Selective Dorsal Root Rhizotomy for Spastic Cerebral Palsy: A Longitudinal Case-Control Analysis of Functional Outcome. Neurosurgery 2019; 87:186-192. [DOI: 10.1093/neuros/nyz422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDThe benefit of selective dorsal rhizotomies (SDR) on motor function relative to the cerebral palsy (CP) natural history remains unknown.OBJECTIVETo determine the functional benefit of SDR over the longitudinal CP natural history.METHODSRetrospective, single-center, case-control study of patients post-SDR after 1990. Inclusion criteria were the following: diagnosis of spastic CP, at least 1 preoperative and 1 postoperative Gross Motor Function Measure (GMFM-88), at least 1 yr of postoperative follow-up. GMFM-88 assessments were performed at 1, 2, 3, 5, 10, and 15 yr postoperatively and converted to GMFM-66. Cases were stratified by preoperative Gross Motor Function Classification System (GMFCS) and matched against their expected natural history using published reference centiles. After age 12, our cohort and matched controls were also fitted to published nonlinear mixed models of GMFM-66 evolution over time.RESULTSAnalysis included 190 patients. Median follow-up, 5.3 yr (range: 1-16.9), median age at surgery, 4.6 yr, and 81.6% of patients grouped as GMFCS II or III pre-op. SDR patients performed statistically significantly better than their expected natural history (P < .0005). At 21 yr old, a modeled benefit of 8.435 was observed for GMFCS I (P = .0051), 0.05 for GMFCS II (P = .9647), 6.31 for GMFCS III (P < .0001), and 1.191 for GMFCS IV patients (P = .0207).CONCLUSIONThese results support the use of SDR in carefully selected spastic CP children.
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Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Canada
| | - Rita Yap
- Physical Therapy, Shriners Hospital for Children, Montreal, Canada
| | - Roy W R Dudley
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
| | - Chantal Poulin
- Division of Neurology, Montreal Children's Hospital, Montreal, Canada
| | - Marie-Andrée Cantin
- Division of Orthopedic Surgery, Department of Pediatric Surgery, CHU Sainte-Justine and Shriners Hospital for Children, Université de Montréal, Montreal, Canada
| | - Thierry E Benaroch
- Division of Orthopedic Surgery, Department of Pediatric Surgery, Montreal Children's Hospital and Shriners Hospital for Children, McGill University, Montreal, Canada
| | - Jean-Pierre Farmer
- Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada
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Summers J, Coker B, Eddy S, Elstad M, Bunce C, Bourmpaki E, Pennington M, Aquilina K, Cawker S, Edwards R, Goodden J, Hawes S, McCune K, Pettorini B, Smith J, Sneade C, Vloeberghs M, Patrick H, Powell H, Verity C, Peacock JL. Selective dorsal rhizotomy in ambulant children with cerebral palsy: an observational cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:455-462. [PMID: 31047843 PMCID: PMC7153769 DOI: 10.1016/s2352-4642(19)30119-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) is an irreversible surgical procedure involving the division of selected sensory nerve roots, followed by intensive physiotherapy. The aim is to improve function and quality of life in children with cerebral palsy and a Gross Motor Function Classification System (GMFCS) level of II or III (walks with or without assistive devices, respectively). We assessed gross motor function before and after SDR and postoperative quality of life in a study commissioned by NHS England. METHODS We did a prospective observational study in five hospitals in England who were commissioned to perform SDR on children aged 3-9 years with spastic diplegic cerebral palsy. The primary outcome was score changes in the 66-item Gross Motor Function Measure (GMFM-66) and seven domains of the Cerebral Palsy Quality of Life Questionnaire ([CP-QoL] social wellbeing and acceptance, feelings about functioning, participation and physical health, emotional wellbeing and self-esteem, access to services, family health, and pain and impact of disability) from before to 24 months after SDR. FINDINGS From Sept 4, 2014, to March 21, 2016, 137 children underwent SDR. The mean age was 6·0 years (SD 1·8). The mean GMFM-66 score increased after SDR with an annual change of 3·2 units (95% CI 2·9 to 3·5, n=137). Of the seven CP-QoL domains, five showed significant improvements over time: feelings about functioning mean annual change 3·0 units (95% CI 2·0 to 4·0, n=133), participation and physical health 3·9 units (2·5 to 5·3, n=133), emotional wellbeing and self-esteem 1·3 units (0·2 to 2·3, n=133), family health 2·0 units (0·7 to 3·3, n=132), and pain and impact of disability -2·5 units (-3·9 to -1·2, n=133). 17 adverse events were reported in 15 children, of which none were severe and 15 (88%) resolved. INTERPRETATION SDR improved function and quality of life in the 24 months after surgery in children with cerebral palsy classified as GMFCS levels II and III. On the basis of these findings, an interim national policy decision was made that SDR would be funded for eligible children in England from 2018. FUNDING National Institute for Health and Care Excellence, National Institute for Health Research Biomedical Research Centre, NHS England.
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Affiliation(s)
- Jennifer Summers
- School of Population Health and Environmental Sciences, King's College London, London, UK.
| | - Bola Coker
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Saskia Eddy
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Maria Elstad
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Catey Bunce
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Elli Bourmpaki
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Mark Pennington
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kristian Aquilina
- Neurosurgery Department, Great Ormond Street Hospital for Children, London, UK
| | - Stephanie Cawker
- Physiotherapy Department, Great Ormond Street Hospital for Children, London, UK
| | - Richard Edwards
- Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - John Goodden
- Neurosurgery Department, Leeds General Infirmary, Leeds, UK
| | - Sally Hawes
- Paediatric Physiotherapy Department, Nottingham University Hospitals, Nottingham, UK
| | - Kate McCune
- Neuro-Rehabilitation and Spascticity Service, Leeds General Infirmary, Leeds, UK
| | - Benedetta Pettorini
- Department of Paediatric Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Jennifer Smith
- Paediatric Physiotherapy, Bristol Royal Hospital for Children, Bristol, UK
| | - Christine Sneade
- Department of Paediatric Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Michael Vloeberghs
- Department of Neurosurgery, Nottingham University Hospitals, Nottingham, UK
| | - Hannah Patrick
- National Institute for Health and Care Excellence, Manchester, UK
| | - Helen Powell
- National Institute for Health and Care Excellence, Manchester, UK
| | - Christopher Verity
- Children's and Adolescent Services, Addenbrooke's Hospital, Cambridge, UK
| | - Janet L Peacock
- School of Population Health and Environmental Sciences, King's College London, London, UK
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Velnar T, Spazzapan P, Rodi Z, Kos N, Bosnjak R. Selective dorsal rhizotomy in cerebral palsy spasticity - a newly established operative technique in Slovenia: A case report and review of literature. World J Clin Cases 2019. [DOI: 10.12998/wjge.v7.i10.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Velnar T, Spazzapan P, Rodi Z, Kos N, Bosnjak R. Selective dorsal rhizotomy in cerebral palsy spasticity - a newly established operative technique in Slovenia: A case report and review of literature. World J Clin Cases 2019; 7:1133-1141. [PMID: 31183344 PMCID: PMC6547316 DOI: 10.12998/wjcc.v7.i10.1133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/23/2019] [Accepted: 05/01/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spasticity affects a large number of children, mainly in the setting of cerebral palsy, however, only a few paediatric neurosurgeons deal with this problem. This is mainly due to the fact that until 1979, when Fasano has published the first series of selective dorsal rhizotomy (SDR), neurosurgeons were able to provide such children only a modest help. The therapy of spasticity has made a great progress since then. Today, peroral drugs, intramuscular and intrathecal medicines are available, that may limit the effects of the disease. In addition, surgical treatment is gaining importance, appearing in the form of deep brain stimulation, peripheral nerve procedures and SDR. All these options offer the affected children good opportunities of improving the quality of life. CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy. Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles. Then, the SDR was made. CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.
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Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- AMEU-ECM Maribor, Ljubljana 1000, Slovenia
| | - Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Zoran Rodi
- Department of Neurophysiology, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Natasa Kos
- Medical Rehabilitation Unit, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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Enslin JMN, Langerak NG, Fieggen AG. The Evolution of Selective Dorsal Rhizotomy for the Management of Spasticity. Neurotherapeutics 2019; 16:3-8. [PMID: 30460456 PMCID: PMC6361072 DOI: 10.1007/s13311-018-00690-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Selective dorsal rhizotomy is a key technique in the surgical management of spasticity in patients with cerebral palsy. The technique evolved from the late 1800s when pioneers like Dana and Abbe performed dorsal rhizotomy in their treatment of refractory pain. These surgeons noted a reduction in muscle tone associated with the operation. When Sherrington then published his Nobel prize-winning work on the corticospinal tract and its role in the neuromuscular system in the 1890s, the course was set for modifying spasticity by aiming surgery at the dorsal roots. This procedure underwent multiple modifications through the next century and today it is, arguably, the most commonly performed operation to treat cerebral palsy children with spasticity. Selective dorsal rhizotomy is a technique that still teaches us a great deal about neurophysiology on a daily basis and it is thanks to the pioneers, described in this article, that we have this tool in our armamentarium.
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Affiliation(s)
- Johannes M Nicolaas Enslin
- Division of Neurosurgery, Grootte Schuur Hospital, OMB H53, University of Cape Town, Observatory, Cape Town, South Africa.
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
| | - Nelleke Gertrude Langerak
- Division of Neurosurgery, Grootte Schuur Hospital, OMB H53, University of Cape Town, Observatory, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Observatory, Cape Town, South Africa
| | - Anthony Graham Fieggen
- Division of Neurosurgery, Grootte Schuur Hospital, OMB H53, University of Cape Town, Observatory, Cape Town, South Africa
- Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Observatory, Cape Town, South Africa
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Gross PH, Bailes AF, Horn SD, Hurvitz EA, Kean J, Shusterman M. Setting a patient-centered research agenda for cerebral palsy: a participatory action research initiative. Dev Med Child Neurol 2018; 60:1278-1284. [PMID: 30132826 DOI: 10.1111/dmcn.13984] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
AIM To establish a patient-centered research agenda for cerebral palsy (CP). METHOD We engaged a large cross-section of the extended community of people living with CP and those providing healthcare to people with CP ('the community') in an educational series and collaborative survey platform to establish an initial list of prioritized research ideas. After online workshops, a facilitated Delphi process was used to select the 20 highest priorities. Select participants attended an in-person workshop to provide comment and work toward consensus of research priorities. RESULTS A research agenda for CP was developed by the community, which included consumers, clinicians, and researchers interested in advancing the established research agenda. The results included the top 16 research concepts produced by the process to shape and steward the research agenda, and an engaged cross-section of the community. INTERPRETATION It has been shown that proactively engaging consumers with clinical researchers may provide more meaningful research for the community. This study suggests that future research should have more focus on interventions and outcomes across the lifespan with increased emphasis on the following outcome measures: function, quality of life, and participation. WHAT THIS PAPER ADDS A patient-centered research agenda for cerebral palsy was established. Comparative effectiveness of interventions, physical activity, and understanding ageing were leading themes. Longitudinal studies across the lifespan, clinical spectrum, and ages were highly ranked. Participants reported high value for participation outcomes. Participants reported great appreciation for the engagement between consumers and clinician researchers.
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Affiliation(s)
- Paul H Gross
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Amy F Bailes
- Division of Occupational Physical Therapy, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Susan D Horn
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Park TS, Edwards C, Liu JL, Walter DM, Dobbs MB. Beneficial Effects of Childhood Selective Dorsal Rhizotomy in Adulthood. Cureus 2017; 9:e1077. [PMID: 28401027 PMCID: PMC5382010 DOI: 10.7759/cureus.1077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Selective dorsal rhizotomy (SDR) has been used to treat children with spastic cerebral palsy (CP) for over three decades. However, little is known about the outcomes of childhood SDR in adults. Objectives: 1) To study the effects of childhood SDR on the quality of life and ambulatory function in adult life. 2) To determine late side effects of SDR in adults. Methods: Adults (> 17.9 years) who underwent SDR in childhood (2 - 17.9 years) between 1987 and 2013 were surveyed in 2015. Patients completed a survey, including questions on demographic information, quality of life, health, surgical outcomes, motor function, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, work status, and side effects of SDR. Results: In our study population of 294 patients (18.0 - 37.4 years), patients received SDR during the ages of 2.0 - 17.9 years and were followed up 2.2 to 28.3 years after surgery. Eighty-four percent had spastic diplegia, 12% had spastic quadriplegia, and 4% had spastic triplegia. The majority (88%) of patients reported improved post-SDR quality of life and 1% considered the surgery detrimental. Most (83%) would recommend the procedure to others and 3% would not. However, patients who would not recommend SDR to others ambulated with a walker or were not ambulatory at all prior to SDR. The majority (83%) of patients improved (30%) or remained stable (53%) in ambulation. Twenty-nine percent of patients reported pain, mostly in the back and lower limbs, with a mean pain level of 4.4 ± 2.4 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in small areas of the lower limbs was reported by 8% of patients, though this did not affect daily life. Scoliosis was diagnosed in 28%, with 40% of these patients pursuing treatment. Whether scoliosis was related to SDR is not clear, though scoliosis is known to occur in patients with CP and also in the general population. Only 4% of patients underwent spinal fusion. Orthopedic surgeries were pursued by 59% of patients. The most common orthopedic surgeries were hamstring lengthenings (31%), Achilles tendon lengthenings (18%), adductor lengthenings (16%), and derotational osteotomies (16%). Twenty-four percent of all patients later underwent hip surgery and 8% had surgeries on their knees. Conclusion: Results of this study indicate that the beneficial effects of childhood SDR extend to adulthood quality of life and ambulatory function without late side effects of surgery.
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Affiliation(s)
- T S Park
- Neurological Surgery, Washington University School of Medicine, St. Louis Children's Hospital
| | - Caleb Edwards
- Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital
| | - Jenny L Liu
- Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital
| | - Deanna M Walter
- Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital
| | - Matthew B Dobbs
- Pediatric Orthopedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital
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20
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Mazarakis NK, Ughratdar I, Vloeberghs MH. Excellent functional outcome following selective dorsal rhizotomy in a child with spasticity secondary to transverse myelitis. Childs Nerv Syst 2015; 31:2189-91. [PMID: 26077594 DOI: 10.1007/s00381-015-2779-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE Selective dorsal rhizotomy (SDR) is a neurosurgical procedure used to treat spasticity in children with cerebral palsy (CP). The vast majority of studies to date suggest SDR is particularly effective in reducing lower limb spasticity in spastic diplegia with long-lasting effect. METHOD We report, to the best of our knowledge for the first time, the case of a teenager who underwent SDR for the management of spasticity secondary to transverse myelitis. RESULTS This is an unusual indication for SDR which resulted in completely loose lower limbs and an excellent functional outcome. At a follow-up 18 months following the procedure, the child had no re-occurrence of his symptoms. CONCLUSION This report raises the possibility that the use of SDR could be expanded to include other pathologies. We discuss the case and the relevant literature. Our spasticity service at NUH has to date inserted 300 baclofen pumps and performed 60 SDRs mainly in children with cerebral palsy.
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Affiliation(s)
- N K Mazarakis
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - I Ughratdar
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - M H Vloeberghs
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Gutknecht SM, Schwartz MH, Munger ME. Ambulatory children with cerebral palsy do not exhibit unhealthy weight gain following selective dorsal rhizotomy. Dev Med Child Neurol 2015; 57:1070-5. [PMID: 25914153 DOI: 10.1111/dmcn.12784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to retrospectively analyze changes in age- and sex-adjusted body mass index (BMI) in ambulatory children with cerebral palsy (CP) who underwent selective dorsal rhizotomy (SDR). METHOD Raw BMI, age- and sex-adjusted BMI z-scores, weight classification status, energy expenditure, and ambulation function were calculated before and after SDR at multiple post-SDR time points: 6 to <24 months, 24 to <48 months, 48 to <72, and 72 to <96 months. Linear mixed models were used to analyze changes in raw BMI, BMI z-scores, energy expenditure, and ambulation function. RESULTS Pre- and post-surgical data were available for 363 children diagnosed with CP who underwent SDR (219 males, 144 females; mean age 6y [SD 2y 1mo]; mean BMI z-score 0.09 [SD 1.21]). Data from additional post-surgical time points were collected on subsamples. Although raw BMI significantly increased (p<0.01), these increases were consistent with anticipated growth. BMI z-scores did not significantly change over the 10-year study period. INTERPRETATION Concerns of unhealthy weight gain following SDR are not supported by this study. Further work examining possible risk factors for BMI increase following SDR, as well as examining disparities in existing criteria for patient selection, is merited.
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Affiliation(s)
- Sarah M Gutknecht
- Orthopedics Department, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Michael H Schwartz
- Department of Orthopaedic Surgery, University of Minnesota - Twin Cities, Minneapolis, MN, USA.,Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
| | - Meghan E Munger
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA
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Abstract
Selective dorsal rhizotomy is a valuable surgical option to manage spasticity in children with bilateral cerebral palsy with the objective of improving function. Choosing the correct patient for rhizotomy requires considerable effort and a comprehensive evaluation. Instrumented three-dimensional gait analysis provides supporting evidence in the selection of the ideal child for SDR as well as enabling quantitative monitoring of outcome and post-operative management up to skeletal maturity.
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Affiliation(s)
- Andrew Roberts
- Orthotic Research and Locomotor Assessment Unit, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom.
| | - Caroline Stewart
- Orthotic Research and Locomotor Assessment Unit, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
| | - Robert Freeman
- Orthotic Research and Locomotor Assessment Unit, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
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Ailon T, Beauchamp R, Miller S, Mortenson P, Kerr JM, Hengel AR, Steinbok P. Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy. Childs Nerv Syst 2015; 31:415-23. [PMID: 25586074 DOI: 10.1007/s00381-015-2614-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/02/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to evaluate long-term outcomes after selective dorsal rhizotomy (SDR) for children with spastic cerebral palsy. METHODS This is a retrospective review of a prospective database of patients who underwent SDR at British Columbia Children's Hospital. Hip adductor spasticity, hip range of motion (ROM), quadriceps strength, and motor function were assessed pre-operatively, at 6 months to 5 years and more than 10 years postoperatively. Patients were stratified by Gross Motor Function Classification System (GMFCS) level into group 1 (GMFCS II and III) and group 2 (GMFCS IV and V). RESULTS Forty-four patients, with mean age at SDR of 4.5 years (range 2.9-7.7), were followed for a mean 14.4 years. Spasticity (Modified Ashworth Scale) decreased 1.5 (p < 0.0001) by early postoperative evaluation with further decrease at late evaluation of 0.8 (p < 0.0001). Early improvement in hip ROM of 13.7 degrees (p < 0.0001) was not sustained at late assessment. Motor function improved in both groups at early assessment but was only sustained in group 1. Group 1 increased 10.0 points (p < 0.0001) at early evaluation with subsequent decrease of 3.5, resulting in an overall increase of 6.6 (p = 0.04) from baseline. Group 2 patients had an initial increase of 8.3 [2.0, 14.6] (p = 0.01) but then declined to 4.9 below baseline (p = 0.3). CONCLUSIONS SDR yields durable reduction in spasticity after 10 years. Early improvements in motor function are present, but at long-term follow-up, these improvements were attenuated in GMFCS II and III and were not sustained in GMFCS IV and V.
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Affiliation(s)
- Tamir Ailon
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and British Columbia Children's Hospital, 4480 Oak St., Room K3-159, Vancouver, BC, V6H 3V4, Canada
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Carraro E, Zeme S, Ticcinelli V, Massaroni C, Santin M, Peretta P, Martinuzzi A, Trevisi E. Multidimensional outcome measure of selective dorsal rhizotomy in spastic cerebral palsy. Eur J Paediatr Neurol 2014; 18:704-13. [PMID: 24954890 DOI: 10.1016/j.ejpn.2014.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/28/2014] [Accepted: 06/01/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND One of the treatment option to reduce spasticity in cerebral palsy children is selective dorsal rhizotomy. Several studies have demonstrated short and long term improvements in gait and other activities after rhizotomy but this surgery still remains a controversial procedure and patient outcome indicators measures are not uniform. AIMS To describe our assessment and outcome evaluation protocol and to verify by this protocol short term results of rhizotomy. METHODS We recruited 9 cerebral palsy children (mean age 7.9 years ± 3.2) affected by mild to moderate spastic diplegia and operated by rhizotomy. Patients were studied preoperatively and at 12 months after surgery by the following clinical and instrumental measures correlated to the International Classification of Functioning: modified Ashworth Scale, passive Range of Motion, Medical Research Council Scale, Selective Motor Control Scale, 3D-motion analysis and energy cost of locomotion measurements (indicators of "body functions"); Gross Motor Functional Measure and Motor Functional Independence Measure (indicators of "activities and participation"). RESULTS Our data showed, after rhizotomy, reduction of spasticity specially in plantarflexors muscles (p < 0.01), increase of strength of knee flexors/extensors and foot plantar/dorsiflexion muscles (p < 0.01), improvement of selective motor control (p < 0.05), more similar spatio-temporal parameters of gait analysis to healthy subjects, reduced equinus foot and knees hyperflexion as energy cost. CONCLUSION The complementary use of multiple indicators may improve the evaluation of the results of dorsal rhizotomy. A beneficial outcome measured by these indicators has been found in our spastic diplegic children one year after rhizotomy.
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Affiliation(s)
- Elena Carraro
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy.
| | - Sergio Zeme
- Functional Neurosurgery Unit, Neuroscience Department, University of Torino, Torino, Italy
| | - Valentina Ticcinelli
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
| | - Carlo Massaroni
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
| | - Michela Santin
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
| | - Paola Peretta
- Department of Pediatric Neurosurgery, Regina Margherita Children's Hospital, Torino, Italy
| | - Andrea Martinuzzi
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
| | - Enrico Trevisi
- "E. Medea" Scientific Institute, Conegliano Research Centre, Conegliano, TV, Italy
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Waqar M, Ellenbogen JR, Kumar R, Sneade C, Zebian B, Williams D, Pettorini BL. Indwelling intrathecal catheter with subcutaneous abdominal reservoir: a viable baclofen delivery system in severely cachectic patients. J Neurosurg Pediatr 2014; 14:409-13. [PMID: 25084089 DOI: 10.3171/2014.6.peds13686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrathecal baclofen (ITB) is a reversible treatment that reduces muscle tone to ameliorate spasticity and dystonia in patients with cerebral palsy (CP). The resulting decrease in energy expenditure allows patients to gain much-needed weight, albeit temporarily. Modern techniques require sufficient abdominal musculature and subcutaneous fat to permit the implantation of an indwelling pump. In patients with extremely low muscle bulk, visceral pumps may be impractical or impossible, with increased risks of dehiscence and infection. The authors describe a variation of the classical procedure in a young patient with severe cachexia. A 10-year-old boy with spastic-dystonic quadriplegic CP was admitted to the neuromedical unit. Numerous drug trials had failed, and surgical intervention was deemed necessary but was complicated by his cachectic body habitus. The authors inserted a lumbar intrathecal catheter and subcutaneously tunneled it to the anterolateral abdomen, where it was connected to a subcutaneous injection port. Baclofen was continuously infused into the subcutaneous port using a noncoring needle connected to an external pump. The needle and line were changed every 5 days to minimize the risk of sepsis. Although other techniques, such as intraventricular baclofen delivery, have been described, these are largely dependent upon sufficient musculature to support a visceral pump. A subcutaneous injection port system represents an alternative approach that reduces the risk of sepsis and may be better tolerated in cachectic patients.
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Affiliation(s)
- Mueez Waqar
- School of Medicine, University of Liverpool; and
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Langerak NG, Vaughan CL, Peter JC, Fieggen AG, Peacock WJ. Long-term outcomes of dorsal rhizotomy. J Neurosurg Pediatr 2013; 12:664-5. [PMID: 24116984 DOI: 10.3171/2013.7.peds13353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bolster EAM, van Schie PEM, Becher JG, van Ouwerkerk WJR, Strijers RLM, Vermeulen RJ. Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Dev Med Child Neurol 2013; 55:610-6. [PMID: 23557106 DOI: 10.1111/dmcn.12148] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study was to evaluate the long-term effect of selective dorsal rhizotomy (SDR) on the gross motor function of ambulant children with spastic bilateral cerebral palsy (CP), compared with reference centiles. METHOD The study used a prospective cohort design and participants comprised 29 children classified using the Gross Motor Function Classification System (GMFCS) in level I (n=7), II (n=4), or III (n=18; 18 males, 11 females; median age at time of surgery 6 y 4 mo; range 2 y 10 mo-12 y 1 mo), who were examined 5 years and 10 years after SDR. We used individual centiles based on Gross Motor Function Measure (GMFM-66) scores and age, corresponding to the GMFCS levels. Individual improvement or deterioration was defined as a change of more than 20 centiles. Side effects experienced and additional treatment received after SDR were also recorded. RESULTS Five years after SDR, 10 out of 28 children showed improvement, and 10 years after SDR 6 out of 20 children had improved. Spinal side effects were noted in two children and hip subluxation in three. Additional treatments included subtalar arthrodesis (n=13), endorotational osteotomy of the tibia (n=5), and botulinum toxin treatment (n=13). INTERPRETATION None of the children showed deterioration of gross motor function based on centile ranking. Five and 10 years after SDR, gross motor function in some children had improved more than would have been expected according to the reference centiles. This suggests, taking the limitations of this study into account, that the applied criteria for selection were adequate. However, the children still required additional treatment after SDR.
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Affiliation(s)
- Eline A M Bolster
- Department of Rehabilitation Medicine, Physiotherapy Section, VU University Medical Center, Amsterdam, the Netherlands
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Hurvitz EA, Marciniak CM, Daunter AK, Haapala HJ, Stibb SM, McCormick SF, Muraszko KM, Gaebler-Spira D. Functional outcomes of childhood dorsal rhizotomy in adults and adolescents with cerebral palsy. J Neurosurg Pediatr 2013; 11:380-8. [PMID: 23394352 DOI: 10.3171/2013.1.peds12311] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this descriptive study the authors evaluated medical outcomes, interventions, satisfaction with life, and subjective impressions about selective dorsal rhizotomy (SDR) in older adolescents and adults who had undergone the procedure as children. METHODS A survey was administered to older adolescents (16-20 years old) and adults with CP who had undergone SDR between 1986 and 2000 at two academic centers. The patients or their caregivers participated in telephone or clinic interviews. Subjective impressions about the SDR and a history of post-SDR medical interventions were obtained. Current functional status, history and ratings of pain, educational achievement, living situation, and subjective health status were also recorded. The Diener Satisfaction with Life Scale (SWLS) was administered. RESULTS Eighty-eight participants, mean age 25.6 ± 4.8 years (mean ± standard deviation), were interviewed at a mean of 19.6 ± 3.0 years after surgery. The distribution of current reported Gross Motor Function Classification System levels was as follows: I, 7%; II, 18%; III, 23%; IV, 36%; and V, 16%. Moreover, 56% of respondents were living with parents and 25% were living alone. Thirty-five percent were employed, and 39% were still in school. The mean overall SWLS score was 26.0 ± 7.3, indicating a high level of satisfaction with life. According to 65% of the patients, the SDR was helpful; 31% were uncertain about the procedure's efficacy. Sixty-five percent would recommend the procedure to others. Fifty-eight percent reported excellent to very good health. Forty-four percent reported pain in the past week. Fifty-one percent reported chronic back pain in general. Logistic regression analysis suggested that an increased satisfaction with life was a predictor (p = 0.01) of an affirmative response to the question about recommending the procedure to others and that better overall health showed a trend toward being such a predictor (p = 0.08). Additional interventions were frequently performed after the SDR. Seventy-four percent of participants underwent orthopedic surgery. Thirty-eight percent were currently taking oral medications for tone, and 53% had received botulinum toxin injections for spasticity treatment. Thirteen patients (15%) had an intrathecal baclofen pump placed. CONCLUSIONS The majority of adults who had undergone SDR as children would recommend the procedure to others. Very few reported negative impressions of the procedure. Levels of satisfaction with life were generally high. Pain prevalence was similar to what has been reported in the literature for adults with cerebral palsy. Despite the SDR, further interventions, both surgical and nonsurgical, were used in the majority of patients.
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Affiliation(s)
- Edward A Hurvitz
- Departments of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan 48108, USA.
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Sam KL, Wang HY, Li C, Lo SK. Item hierarchy of the Chinese version of cerebral palsy quality of life for children. Eur J Paediatr Neurol 2013; 17:126-34. [PMID: 22750348 DOI: 10.1016/j.ejpn.2012.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/28/2012] [Accepted: 06/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Chinese Cerebral Palsy Quality of Life for Children (C CP QOL-Child) is the first instrument developed to measure quality of life of (QOL) children with cerebral palsy in Chinese speaking populations. OBJECTIVE The aim of the study was to examine the psychometric properties of C CP QOL-Child using Item Response Theory Models. We were particularly interested to know how intervention strategies could be designed for individuals based on the item scores. METHODS 145 primary caregivers (mostly mothers; mean age: 39.2) of children with cerebral palsy aged 4-12 were invited to complete the 65-item C CP QOL-Child questionnaire. Data were analyzed using Rasch analysis. RESULTS Item difficulty estimates were aligned with person ability values, indicating that the items in the scale generally demonstrated an appropriate depth and width for measuring QOL of persons in the target population. The results also showed that after dropping the 8 items in the dimension pain and impact of disability in the 65-item scale, the revised 57-item scale exhibits unidimensionality (separation index = 4.43, r = 0.95); hence the total score computed from the 57 items adequately reflects the level of QOL of the child as perceived by the caregiver. We further found that the Rasch item difficulty estimates demonstrated an overall item hierarchy; hence therapists can expect a pattern of performance by a child with CP that is based on the established order of item difficulty. CONCLUSIONS The hierarchical structure identified in the study may be useful for designing tailor-made interventions with an aim of improving QOL.
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Affiliation(s)
- Ka-Lam Sam
- Faculty of Art and Science, The Hong Kong Institute of Education, Hong Kong
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Josenby AL, Wagner P, Jarnlo GB, Westbom L, Nordmark E. Motor function after selective dorsal rhizotomy: a 10-year practice-based follow-up study. Dev Med Child Neurol 2012; 54:429-35. [PMID: 22435543 DOI: 10.1111/j.1469-8749.2012.04258.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore changes in motor function up to 10 years after selective dorsal rhizotomy (SDR). METHOD The participants comprised 29 children (20 males, nine females) with bilateral spastic diplegia who were consecutively operated on at a median age of 4 years and 3 months and followed until a median age of 15 years. SDR was combined with physiotherapy and regular follow-up visits. The distribution of preoperative Gross Motor Function Classification System (GMFCS) levels was as follows: I, n=1; II, n=7; III, n=8; IV, n=12; and V, n=1. Muscle tone in hip flexors, hip adductors, knee flexors, and plantar flexors was assessed with the modified Ashworth scale, passive range of motion in hip abduction, popliteal angle, maximum knee extension, dorsiflexion of the foot was measured with a goniometer, and gross motor function was assessed using the Gross Motor Function Measure (GMFM-66). The results were compared with preoperative values, taking into account age at the time of SDR. RESULTS After 10 years, muscle tone in hip flexors, hip adductors, knee flexors and plantar flexors was normalized in 19, 24, 13 and 23 participants respectively; mean change in passive range of motion ranged from -2.0° to 8.6°, and the mean increase in GMFM-66 was 10.6. Changes in GMFM-66 were associated with preoperative GMFCS level and GMFM-66 scores. INTERPRETATION Children who underwent SDR and physiotherapy and were regularly followed up by an experienced team showed improved gross motor function for up to 10 years postoperatively.
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Affiliation(s)
- Annika Lundkvist Josenby
- Division of Physiotherapy, Department of Health Sciences, Health Sciences Centre, Lund University, Lund, Sweden.
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Gait status 17-26 years after selective dorsal rhizotomy. Gait Posture 2012; 35:244-9. [PMID: 22050972 DOI: 10.1016/j.gaitpost.2011.09.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/07/2011] [Accepted: 09/14/2011] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to use three-dimensional gait analysis to describe the gait status of adults with spastic diplegia who underwent selective dorsal rhizotomy (SDR) in childhood. Outcome measures were the gait deviation index (GDI), non-dimensional temporal-distance parameters, and kinematics of the lower limbs. A total of 31 adults with spastic diplegia who had previously undergone SDR were eligible and participated in current study (SDR group). These participants had a median age of 26.8 years (range 21-44 years) with a mean time between surgery and assessment of 21.2±2.9 years (range 17-26 years). For comparison purposes, 43 typically developed adults also participated (CONTROL group), with a median age of 28.3 years (range 21-45 years). More than 17 years after SDR 58% of the SDR group showed improved GMFCS levels, while none of them deteriorated. The participants in the SDR group walked with a mild crouch gait, although there was a loading response, adequate swing-phase knee flexion, adequate swing-phase plantarflexion, reasonable speed and cadence. The gait status of the SDR group more than 17 years after SDR was similar to what has been reported in short-term follow-up studies, as well as our earlier 20 year follow-up study that did not include 3D gait analysis. Appropriate orthopaedic intervention was required in 61% of the study cohort. Whether the types and numbers of orthopaedic interventions are positively affected by SDR remains an open question. Further studies examining this question are warranted. In addition, long-term follow-up studies focused on other interventions would also be of clinical relevance.
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Tedroff K, Löwing K, Jacobson DNO, Åström E. Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy. Dev Med Child Neurol 2011; 53:724-9. [PMID: 21585367 DOI: 10.1111/j.1469-8749.2011.03969.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to evaluate the long-term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP). METHOD Nineteen children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and 10 years after SDR. Assessments included the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure 88 (GMFM-88) and the Wilson gait scale for ambulation, neurological investigations, and passive joint range of motion assessment. A 10-year retrospective chart review was added for orthopaedic surgery after SDR. RESULTS Baseline muscle tone at the hip, knee, and ankle level displayed a high degree of spasticity that normalized after SDR. After 10 years there was a slight recurrence of spasticity at the knee and ankle. Joint range of motion declined from a maximum at 3 years after SDR to the 10-year follow-up. Median ambulatory status was best 3 years after SDR and then declined. The GMFM-88 score increased from the median baseline value of 51 to 66 (p=0.002) and 76 (p<0.001) at the initial follow-ups. After 10 years there was a decline in gross motor function with a reduction in the GMFM-88 score to 62 (p=0.022). Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries (SD 2.8), soft tissue surgery being the most common. INTERPRETATION The spasticity-reducing effect of SDR, although pronounced, did not seem to improve long-term functioning or prevent contractures. This suggests that contracture development in CP is not mediated by spasticity alone.
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Affiliation(s)
- Kristina Tedroff
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
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Kembhavi G, Darrah J, Payne K, Plesuk D. Adults with a diagnosis of cerebral palsy: a mapping review of long-term outcomes. Dev Med Child Neurol 2011; 53:610-4. [PMID: 21418196 DOI: 10.1111/j.1469-8749.2011.03914.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM Cerebral palsy (CP) is recognized as a lifespan condition. This mapping review identifies outcomes that have been measured in adults with CP between 1970 and 2010 to determine if either the outcomes evaluated or the research methodologies have changed substantially. METHOD We performed a literature review. For studies to be included, participants had to be 16 years or older and 80% of the sample had to have a diagnosis of CP. Articles were grouped by decade, and outcomes were categorized using the International Classification of Functioning, Disability and Health (ICF) framework and terminology. RESULTS Fifty-eight articles were included in the mapping review. Both the number of studies and the types of outcomes investigated increased from 1970 to 2010. Outcomes representing the ICF component of Body Function and Structure were present across the period reviewed, whereas interest in contextual (personal or environmental) factors has primarily emerged since 2000. INTERPRETATION Gaps were identified by the mapping review. Large age ranges and heterogeneity of sample populations made it difficult to determine if the outcomes reported were due to ageing or the long-term consequences of CP. In addition, most reviewed articles described outcomes categorically, with few papers providing explanations or solutions to reported outcomes.
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Affiliation(s)
- Gayatri Kembhavi
- Centre for International Health and Development, University College London, London, UK.
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Grunt S, Becher JG, Vermeulen RJ. Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2011; 53:490-8. [PMID: 21518341 DOI: 10.1111/j.1469-8749.2011.03912.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To assess the long-term outcome and adverse events of selective dorsal rhizotomy (SDR) in children with spastic cerebral palsy (CP). METHOD Studies were selected based on the following inclusion criteria: children with CP that underwent SDR with a follow-up period of at least 5 years. The following databases were searched: MEDLINE, Web of Science, Embase, PEDro, and the Cochrane library. Studies meeting the inclusion criteria were scored by two reviewers, who graded the level of evidence and the quality/conduct of the studies. Outcomes were classified according to the International Classification of Functioning, Disability and Health (ICF). RESULTS Only three of the 21 studies who met the inclusion criteria allowed a tentative conclusion on outcome. There is moderate evidence that SDR has a positive long-term influence on the ICF body structure and body function domains but there is no evidence that SDR has an influence on the ICF activity and participation domains. Spinal abnormalities seem to be common, but no conclusion can be drawn about their relation to SDR. INTERPRETATION There is lack of evidence concerning the long-term outcomes after SDR. Future studies need to clarify the long-term influence of SDR - especially in the ICF domains of activity and participation.
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Affiliation(s)
- Sebastian Grunt
- Department of Paediatric Neurology, University Children's Hospital, Inselspital, Berne, Switzerland
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35
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Camfield P, Camfield C. Transition to adult care for children with chronic neurological disorders. Ann Neurol 2011; 69:437-44. [DOI: 10.1002/ana.22393] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/02/2011] [Accepted: 02/07/2011] [Indexed: 11/11/2022]
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Cerniauskaite M, Quintas R, Boldt C, Raggi A, Cieza A, Bickenbach JE, Leonardi M. Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation. Disabil Rehabil 2010; 33:281-309. [PMID: 21073361 DOI: 10.3109/09638288.2010.529235] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001. METHOD The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application. RESULTS A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009. CONCLUSIONS The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.
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Affiliation(s)
- Milda Cerniauskaite
- Neurology, Public Health and Disability Unit-Scientific Directorate, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
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Wang HY, Cheng CC, Hung JW, Ju YH, Lin JH, Lo SK. Validating the Cerebral Palsy Quality of Life for Children (CP QOL-Child) questionnaire for use in Chinese populations. Neuropsychol Rehabil 2010; 20:883-98. [PMID: 20859827 DOI: 10.1080/09602011.2010.509190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to examine the psychometric properties of the Chinese version of Cerebral Palsy Quality of Life for Children (CP QOL-Child) questionnaire. We performed forward (into Chinese) and backward translation of the CP QOL-Child for: (1) the primary caregiver form (for parents of children with CP aged 4-12 years); and (2) the child self-report form (for children with cerebral palsy aged 9-12 years). Psychometric properties assessed included test-retest reliability, internal consistency, item discrimination, construct validity, and concordance between the forms of questionnaire. The Chinese CP QOL-Child was completed by 145 caregivers and 44 children. Excellent test-retest reliability and internal consistency were obtained. Item discrimination analysis revealed a majority of the items have moderate to good discriminating power. Confirmatory factor analysis demonstrated distinguishable domain structure as on the original English version. Significant associations were found between lower QOL and more severe motor disability. Consistent with the English version, the highest correlation between the primary caregiver and child forms on QOL was in the domain of functioning. Results of this study indicate that the Chinese CP QOL-Child appears to be valid for use in Mandarin-Chinese speaking children with cerebral palsy.
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Affiliation(s)
- H-Y Wang
- Department of Physical Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hosalkar H, Pandya NK, Hsu JE, Kamath AF, Keenan MA. What's new in orthopaedic rehabilitation. J Bone Joint Surg Am 2010; 92:1805-12. [PMID: 20660246 DOI: 10.2106/jbjs.j.00335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Harish Hosalkar
- Rady Children's Hospital, University of California, San Diego, 3030 Children's Way, Suite 410, San Diego, CA 92123, USA.
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Salghetti AM, Betto S, Russo E, Petacchi E, Pradal M, Martinuzzi A. Projecting and programming rehabilitation based on ICF-CY format in a neuropediatric hospital unit. Disabil Rehabil 2009; 31 Suppl 1:S55-60. [DOI: 10.3109/09638280903317864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Langerak NG, Vaughan CL, Hoffman EB, Figaji AA, Fieggen AG, Peter JC. Incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective dorsal rhizotomy. Childs Nerv Syst 2009; 25:1593-1603. [PMID: 19784657 DOI: 10.1007/s00381-009-0993-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the mechanical status of the spine in patients with spastic diplegia 17-26 years after selective dorsal rhizotomy (SDR). METHODS We compared original radiographic reports from our earlier short-term follow-up study with current X-rays. In addition, we obtained magnetic resonance images (MRI) of the spine and additional information regarding back pain and clinical assessments. RESULTS Thirty patients (17 males and 13 females; median age 26.8 years) participated in the current study, with median follow-up times of 4.0 and 21.4 years. Comparison of the X-ray results showed respectively: scoliosis 0% and 57%; kyphosis 0% and 7%; lordosis 21% and 40%; spondylolysis 18% and 37%; and spondylolisthesis grade I occurred in one patient. The only statistically significant difference was found for scoliosis (p < 0.01). The majority had Cobb angles <30 degrees with only two patients with curves of 35 degrees. MRI scans showed spinal stenosis in 27%, black discs in 10%, and disc protrusion in 3%. Daily back pain was reported in 17%, while 23% reported "moderate disability" as a result of back and leg pain. No patient to date has required any surgical intervention on the spine. CONCLUSIONS Except for spondylolisthesis, spinal deformities did appear to progress with time. However, this increase was not marked, and the development of relatively mild scoliosis was the only statistically significant increase. This group of patients requires continued follow-up. Further studies are required to ascertain the natural history of spinal deformity in adults with spastic diplegia who have not had SDR.
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Affiliation(s)
- Nelleke G Langerak
- MRC/UCT Medical Imaging Research Unit, Department of Human Biology, University of Cape Town, Observatory, Cape Town, Western Cape 7925, South Africa.
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