163 Beneficial Functional Outcomes of Selective Dorsal Rhizotomy (SDR) Are Long Lasting and Alter the Natural History of Motor Development in Spastic Cerebral Palsy

For decades, intraoperative neurophysiological monitoring (IONM) has been used to guide selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy (CP). Electromyography (EMG) interpretation methods, which are the core of IONM, have never been fully discussed and addressed, and their importance and necessity in SDR have been questioned for years. However, outcomes of CP patients who have undergone IONM-guided SDR have been favorable, and surgery-related complications are extremely minimal. In this paper, we review the history of evolving EMG interpretation methods as well as their neuroelectrophysiological basis.

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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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Selective Dorsal Rhizotomy for Spastic Cerebral Palsy

Pediatric Neurosurgery ◽

10.1055/b-0034-72758 ◽

2008 ◽

Keyword(s):

Cerebral Palsy ◽

Spastic Cerebral Palsy ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy

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Deformity of lumbar spine after selective dorsal rhizotomy for spastic cerebral palsy

Microsurgery ◽

10.1002/micr.20444 ◽

2007 ◽

Vol 28 (1) ◽

pp. 10-12 ◽

Cited By ~ 19

Author(s):

Zhiyong Li ◽

Jiakai Zhu ◽

Xiaolin Liu

Keyword(s):

Cerebral Palsy ◽

Lumbar Spine ◽

Spastic Cerebral Palsy ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy

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Variation between Centers in Electrophysiologic Techniques Used in Lumbosacral Selective Dorsal Rhizotomy for Spastic Cerebral Palsy

Pediatric Neurosurgery ◽

10.1159/000121131 ◽

1996 ◽

Vol 25 (5) ◽

pp. 233-239 ◽

Cited By ~ 24

Author(s):

Paul Steinbok ◽

John R. Kestle

Keyword(s):

Cerebral Palsy ◽

Spastic Cerebral Palsy ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy

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Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy

Journal of Neurosurgery ◽

10.3171/jns.1999.91.5.0727 ◽

1999 ◽

Vol 91 (5) ◽

pp. 727-732 ◽

Cited By ~ 51

Author(s):

Jack R. Engsberg ◽

Sandy A. Ross ◽

Tae Sung Park

Keyword(s):

Cerebral Palsy ◽

Physical Therapy ◽

Spastic Cerebral Palsy ◽

Control Group ◽

Selective Dorsal Rhizotomy ◽

Content Type ◽

Dorsal Rhizotomy ◽

Angle Data ◽

Work Done ◽

Fine Print

Object. In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP).Methods. Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values.Conclusions. The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.

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