Response to Letter regarding ”Motor and functional outcome of selective dorsal rhizotomy in children with spastic diplegia at 12 and 24 months of follow-up”

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.

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

Gait & Posture ◽

10.1016/j.gaitpost.2018.06.002 ◽

2018 ◽

Vol 64 ◽

pp. 108-113 ◽

Cited By ~ 6

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

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Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with spastic diplegia

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.2.peds10452 ◽

2011 ◽

Vol 7 (5) ◽

pp. 557-562 ◽

Cited By ~ 35

Author(s):

Petra E. M. van Schie ◽

Maaike Schothorst ◽

Annet J. Dallmeijer ◽

R. Jeroen Vermeulen ◽

Willem J. R. van Ouwerkerk ◽

...

Keyword(s):

Botulinum Toxin ◽

Motor Function ◽

Botulinum Toxin Type A ◽

Spastic Diplegia ◽

Selective Dorsal Rhizotomy ◽

Gross Motor ◽

Gross Motor Function ◽

Dorsal Rhizotomy

Object The primary aim of this prospective cohort study was to evaluate the short-term (1 year) and long-term (mean 6 years) effects of selective dorsal rhizotomy (SDR) on gross motor function and spasticity in ambulatory children with spastic diplegia. Secondary aims were to investigate side effects, additional treatment during follow-up (botulinum toxin type A injections or orthopedic surgery), and parental satisfaction. Methods Thirty-three children who had undergone SDR at a mean age of 6 years and 7 months (± 2 years) were included. There were 7 children at Gross Motor Function Classification System (GMFCS) Level I, 7 at Level II, and 19 at Level III. Gross motor function was assessed with the Gross Motor Function Measure–66 (GMFM-66). Spasticity was measured according to a modified Tardieu scale. Side effects, additional treatment, and parental satisfaction were recorded using a parental questionnaire and medical records. Results At 1-year follow-up, mean GMFM-66 scores improved significantly by 4.3 ± 4.1 points. Children at GMFCS Levels I and II showed significantly more improvement (7.2 points) on the GMFM-66 compared with children at GMFCS Level III (2.9 points). On long-term follow-up (mean 6 years ± 22 months), mean GMFM-66 scores improved significantly by 6.5 ± 5.9 points, without a difference between children at GMFCS Levels I and II and Level III. No relapse of spasticity was noted. Ten children (30%) needed orthopedic surgery and 13 children (39%) received botulinum toxin type A treatment after SDR. Twenty (91%) of the 22 parents who answered the questionnaire at long-term follow-up believed that their child's functioning had improved after SDR. Conclusions Selective dorsal rhizotomy resulted in short- and long-term improvements in gross motor function, without relapse of spasticity. However, the majority of the children still needed additional surgery or botulinum toxin A treatment.

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Functional Outcome of Adulthood Selective Dorsal Rhizotomy for Spastic Diplegia

Cureus ◽

10.7759/cureus.5184 ◽

2019 ◽

Author(s):

TS Park ◽

So Yeon Uhm ◽

Deanna M Walter ◽

Nicole L Meyer ◽

Matthew B Dobbs

Keyword(s):

Functional Outcome ◽

Spastic Diplegia ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy

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A long-term follow-up study of spinal abnormalities and pain in adults with cerebral palsy and spastic diplegia more than 25 years after selective dorsal rhizotomy

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20751 ◽

2020 ◽

pp. 1-8

Author(s):

Berendina E. Veerbeek ◽

Robert P. Lamberts ◽

A. Graham Fieggen ◽

Ncedile Mankahla ◽

Richard V. P. de Villiers ◽

...

Keyword(s):

Cerebral Palsy ◽

Spastic Diplegia ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Follow Up Study ◽

Long Term Follow Up ◽

Lumbar Hyperlordosis ◽

Thoracic Hyperkyphosis

OBJECTIVEThe main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR.METHODSThis is a 9-year follow-up study with data collection conducted in 2008 and 2017. Radiographs were assessed for the degree of scoliosis, thoracic kyphosis and lumbar lordosis curvatures, and prevalence of spondylolysis and spondylolisthesis, while level of pain and disability was determined with a self-developed questionnaire and the Oswestry Disability Index (ODI) questionnaire, respectively.RESULTSTwenty-five participants were included (15 males; median age 35.9 years, IQR 34.3–41.5 years), with a follow-up time after SDR ranging from 25 to 35 years. No clinically relevant changes were found for spinal curvatures, spondylolysis and spondylolisthesis, perceived pain frequency, and ODI scores between 2008 and 2017. While the prevalence of spondylolysis was 44%, spondylolisthesis was found in 20% (of whom 15% were grade I and 5% grade II), lumbar hyperlordosis was found in 32%, thoracic hyperkyphosis in 4%, and scoliosis in 20%. The Cobb angle was < 25°, and no patient required surgery for scoliosis. In addition, the low back was reported as the most common site of pain, with 28% of the adults with CP having daily pain. This resulted in 80% of the cohort indicating none or minimal disability due to pain based on the ODI. The only correlation found was between hyperkyphosis and female gender.CONCLUSIONSAt follow-up more than 25 years after SDR, no progression in spinal abnormalities, level of pain, and disability was found when compared with findings 15 years after SDR. The prevalence of scoliosis, thoracic hyperkyphosis, and lumbar hyperlordosis was within the range reported for adults with CP, while spondylolysis and spondylolisthesis occurred more often than would be expected. It is difficult, however, to establish the role of SDR in this finding, given the limited data on the natural history of CP. Despite the encouraging outcome of this long-term follow-up study after SDR, it is important to continue monitoring adults with CP during the aging process.

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A 2-year follow-up of outcomes following orthopedic surgery or selective dorsal rhizotomy in children with spastic diplegia

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-200411000-00002 ◽

2004 ◽

Vol 13 (6) ◽

pp. 358-366 ◽

Cited By ~ 30

Author(s):

Susan Sienko Thomas ◽

Cathleen E. Buckon ◽

Joseph H. Piatt ◽

Michael D. Aiona ◽

Michael D. Sussman

Keyword(s):

Orthopedic Surgery ◽

Spastic Diplegia ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy

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Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

10.21203/rs.3.rs-278334/v1 ◽

2021 ◽

Author(s):

wenbin jiang ◽

Shuyun Jiang ◽

Yan Yu ◽

Qijia Zhan ◽

Min Wei ◽

...

Keyword(s):

Cerebral Palsy ◽

Lower Limbs ◽

Spastic Cerebral Palsy ◽

Selective Dorsal Rhizotomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Dorsal Rhizotomy ◽

Gait Parameters

Abstract Background Selective Dorsal Rhizotomy (SDR) guided by our modified protocol can decrease spasticity in certain muscles. This study aimed to investigate gait parameters changes in cerebral palsy (CP) with focal spasticity after SDR in short-term follow-up. Methods CP classified as Gross Motor Function Classification System (GMFCS) level Ⅰ and Ⅱ who underwent SDR were included. Changes of spasticity, gait parameters and gait deviation index (GDI) were retrospectively reviewed. Results This study contained 26 individuals with 44 affected and 8 intact lower limbs (4 monoplegia, 4 hemiplegia and 18 diplegia). Mean age was 5.7 ± 1.9 years-old and follow-up duration was 9.9 ± 6.6 months. After SDR, average spasticity of 108 target muscles decreased from 2.9 ± 0.8 to 1.8 ± 0.6 in Modified Ashworth Scale (MAS). Kinematic curves changed after the surgery in sagittal and transverse plane in affected sides, further investigation showed improvements in ankle and knee. No changes were found in temporal-spatial parameters except decrease in cadence in affected sides. GDI improved significantly in affected limbs. Conclusion In short-term follow up, the new-protocol-guiding SDR can lower focal spasticity, GA showed improvements in kinematic parameters and GDI. Longer follow-up duration is needed to clarify the long-term outcome.

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

10.21203/rs.3.rs-35375/v1 ◽

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.

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

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.12.004 ◽

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.

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