scholarly journals Motor and functional outcome of selective dorsal rhizotomy in children with spastic diplegia at 12 and 24 months of follow-up

2021 ◽  
Author(s):  
Tarik Alp Sargut ◽  
Hannes Haberl ◽  
Simone Wolter ◽  
Sascha Tafelski ◽  
Anne van Riesen ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Evaluation Process ◽  
Knee Extension ◽  
Spastic Diplegia ◽  
Medical Council ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Time Period ◽  
Modified Ashworth Scale ◽  
The Right

Abstract Background Selective dorsal rhizotomy (SDR) in ambulatory children affected by cerebral palsy (CP) is a surgical treatment option to lower spasticity and thereby improve gait and ambulation. The aim of the current study is to investigate the outcome of children with respect to spasticity, muscle strength, and overall function after SDR. Methods All children who underwent SDR via a single-level laminotomy in the time period from January 2007 to April 2015 at our center were enrolled in this study. Within a standardized evaluation process, the following was assessed routinely pre-operatively and 12 and 24 months following surgery: extent of spasticity at hip adductors and hamstrings as characterized by the Modified Ashworth Scale (MAS), maximal muscle strength as characterized by the Medical Council Research Scale (MRC), overall function regarding ambulation as characterized by the Gross Motors Function Classification System (GFMCS), and overall function as characterized by the Gross Motor Function Measure (GMFM-88). Results Matching sets of pre- and post-operative assessments of the chosen outcome parameters were available for 109 of the 150 children who underwent SDR within the observation period. After 24 months, the MAS scores of hip adductors (n = 59) improved in 71% and 76% of children on the right and left side, respectively. In 20% and 19%, it remained unchanged and worsened in 9% and 5% of children on the right and left side, respectively (p < 0.00625). For hamstrings, the rates for the right and left sides were 81% and 79% improvement, 16% and 16% unchanged, and 4% and 5% worsened, respectively (p < 0.00625). Muscle strength of ankle dorsiflexion and knee extension significantly improved after 24 months. Overall function assessed by GMFM-88 improved significantly by 4% after 12 months (n = 77) and by 7% after 24 months (n = 56, p < 0.0001). Conclusions The presented data underlines the benefit of SDR in a pediatric patient collective with bilateral spastic CP. The procedure resulted in an effective and permanent reduction of spasticity and improved overall function without causing relevant weakness of the lower extremities.

Objective measurement of muscle strength in children with spastic diplegia after selective dorsal rhizotomy

2002 ◽  
Vol 83 (4) ◽  
pp. 454-460 ◽  
Author(s):  
Cathleen E. Buckon ◽  
Susan Sienko Thomas ◽  
Gerald E. Harris ◽  
Joseph H. Piatt ◽  
Michael D. Aiona ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Objective Measurement ◽  
Spastic Diplegia ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy

scholarly journals No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

2020 ◽  
Author(s):  
Annika Lundkvist Josenby ◽  
Lena Westbom
Keyword(s):  
Spinal Pain ◽  
Control Group ◽  
Spastic Diplegia ◽  
Selective Dorsal Rhizotomy ◽  
Gross Motor ◽  
Dorsal Rhizotomy ◽  
Severe Spasticity ◽  
Increased Risk ◽  
Group Frequency ◽  
Gmfcs Level

Abstract Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery increases the risk for later spine problems. Using CP-registry data from a geographically defined population with the same health care and habilitation services, the objectives were to compare reported scoliosis and spinal pain up to adult age in all SDR-operated with all non-SDR-operated individuals with same medical history, functional abilities, and level of spasticity at four years of age. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990-2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at four years of age and were included; 36 persons had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 individuals constituting the control group, had not. Data on scoliosis and spinal pain at 10, 15, 20 and 25 years of age were analyzed using Kaplan-Meier survival curves and Fisher’s exact test. Gross motor function classification (GMFCS) levels at four years of age (or pre-operatively) were used for stratification.Result Presence of scoliosis at 15, 20, and 25 years of age was the same in the SDR group as in the control group (p=0.734, 0.735 and 1.0). In severe functional disability (GMFCS IV), the SDR group had later onset and lower occurrence of scoliosis (p=0.004) than the control group. Frequency of reported spinal pain did not differ between the groups. Conclusion Neither scoliosis, nor spinal pain was more frequent after SDR than expected by natural history. On the contrary, in severe CP (GMFCS level IV), scoliosis was less frequently reported and had a later onset in the SDR group than in the same GMFCS-level control group.

Selective dorsal rhizotomy in children with spastic hemiparesis

2010 ◽  
Vol 6 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Allison Oki ◽  
Wende Oberg ◽  
Beth Siebert ◽  
Dutch Plante ◽  
Marion L. Walker ◽  
...  
Keyword(s):  
Stride Length ◽  
The Other ◽  
Assessment Scale ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Spastic Hemiparesis ◽  
Gait Assessment ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

Object Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. Methods A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Results Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Conclusions Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

scholarly journals Soft Tissue Release and Osteotomies in the Treatment of Patients with Spastic Diplegic Cerebral Palsy

2018 ◽  
Vol 24 (1) ◽  
pp. 80-83
Author(s):  
Ng Bobby Kin-Wah ◽  
Chau Wai-Wang ◽  
Hung Alec Lik-Hang ◽  
Lam Tsz-Ping ◽  
Cheng Jack Chun-Yiu
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Soft Tissue Release ◽  
Spastic Diplegia ◽  
Single Event ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Surgery Patient ◽  
Before And After ◽  
Mid Term Results

We aim to study the outcome of soft tissue releases by tendon elongations and osteotomies in fixed joint contractures by clinical examination and patient self-reported assessment on 20 patients (14 males and 6 females) with spastic diplegic cerebral palsy treated with single-event multilevel surgery (SEMLS) between 2000 and 2012. A questionnaire was used to collect information on problems encountered before and after surgery and decision on surgery. Comparing patients with Gross Motor Function Classification System class I/II, (N = 8), III (N = 8) and IV/V, patients of classes IV/V showed much slower mean recovery time than I/II group (14.00 vs. 4.38 months, p < 0.01). SEMLS in the treatment of patients with spastic diplegia had good mid-term results in most patients. The patients who had unfavourable outcomes are associated with mental retardation, general or local complications and previous selective dorsal rhizotomy surgery. Patient selection and good rehabilitations preoperation and postoperation provided the most favourable outcomes of SEMLS.

scholarly journals Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria

2013 ◽  
Vol 35 (5) ◽  
pp. E6 ◽  
Author(s):  
William C. Gump ◽  
Ian S. Mutchnick ◽  
Thomas M. Moriarty
Keyword(s):  
Cerebral Palsy ◽  
Spinal Cord Injuries ◽  
Spastic Diplegia ◽  
Inclusion Criteria ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Common Diagnosis

Children with spastic diplegia from cerebral palsy (CP) experience measurable improvement in their spasticity and motor function following selective dorsal rhizotomy (SDR). The role of this operation in the treatment of other spasticity causes is less well defined. A literature review was undertaken to survey outcomes from SDRs performed outside the CP population. Multiple sclerosis was the most common diagnosis found, accounting for 74 of 145 patients described. Selective dorsal rhizotomies have also been reported in patients with traumatic brain and spinal cord injuries, ischemic and hemorrhagic stroke, neurodegenerative disease, hypoxic encephalopathy, and other causes of spasticity. Outcomes from surgery are generally described as favorable, although postoperative assessments and follow-up times are not standardized across reports. Long-term outcomes are sparsely reported. Larger numbers of patients and more detailed outcomes data have the potential to form a basis for expanding the inclusion criteria for SDR.

Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: A 10 year follow-up study

2018 ◽  
Vol 64 ◽  
pp. 108-113 ◽  
Author(s):  
Marianna Romei ◽  
Laura M. Oudenhoven ◽  
Petra E.M. van Schie ◽  
Willem J.R. van Ouwerkerk ◽  
Marjolein M. van der Krogt ◽  
...  
Keyword(s):  
Young Adults ◽  
Adolescents And Young Adults ◽  
Spastic Diplegia ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Follow Up Study

Developmental skills of children with spastic diplegia: Functional and qualitative changes after selective dorsal rhizotomy

1997 ◽  
Vol 78 (9) ◽  
pp. 946-951 ◽  
Author(s):  
Cathleen E. Buckon ◽  
Susan Sienko Thomas ◽  
Rosemary Pierce ◽  
Joseph H. Piatt ◽  
Michael D. Aiona
Keyword(s):  
Spastic Diplegia ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Developmental Skills ◽  
Qualitative Changes

Effects of Selective Dorsal Rhizotomy for Spastic Diplegia on Hip Migration in Cerebral Palsy

1994 ◽  
Vol 20 (1) ◽  
pp. 43-49 ◽  
Author(s):  
T.S. Park ◽  
George P. Vogler ◽  
Lawrence H. Phillips ◽  
Bruce A. Kaufman ◽  
Madeleine R. Ortman ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Spastic Diplegia ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Hip Migration

Spasticity and strength changes as a function of selective dorsal rhizotomy

1998 ◽  
Vol 88 (6) ◽  
pp. 1020-1026 ◽  
Author(s):  
Jack R. Engsberg ◽  
Kenneth S. Olree ◽  
Sandy A. Ross ◽  
T. S. Park
Keyword(s):  
Knee Extension ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Resistive Torque ◽  
Angle Data ◽  
Hamstring Muscles ◽  
Work Done ◽  
Torque Angle ◽  
Fine Print

Object. The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy. Methods. Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque—angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work—velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque—angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however, they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. Conclusions. The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.

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