Functional Outcome of Adulthood Selective Dorsal Rhizotomy for Spastic Diplegia

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

Neurosurgical FOCUS ◽

10.3171/2013.8.focus13294 ◽

2013 ◽

Vol 35 (5) ◽

pp. E6 ◽

Cited By ~ 20

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.

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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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Sustained non-spastic gait pattern more than 25-years after Selective Dorsal Rhizotomy in adults with Cerebral Palsy and spastic diplegia

Gait & Posture ◽

10.1016/j.gaitpost.2019.07.118 ◽

2019 ◽

Vol 73 ◽

pp. 230-231

Keyword(s):

Cerebral Palsy ◽

Gait Pattern ◽

Spastic Diplegia ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Spastic Gait

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

Archives of Physical Medicine and Rehabilitation ◽

10.1016/s0003-9993(97)90055-1 ◽

1997 ◽

Vol 78 (9) ◽

pp. 946-951 ◽

Cited By ~ 14

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

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

Pediatric Neurosurgery ◽

10.1159/000120763 ◽

1994 ◽

Vol 20 (1) ◽

pp. 43-49 ◽

Cited By ~ 31

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

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No Support that Early Selective Dorsal Rhizotomy Increase Frequency of Scoliosis and Spinal Pain – a longitudinal population-based register study from four to 25 years of age

10.21203/rs.3.rs-35375/v2 ◽

2020 ◽

Author(s):

Annika Lundkvist Josenby ◽

Lena Westbom

Keyword(s):

Logistic Regression ◽

Motor Development ◽

Spinal Pain ◽

Spastic Diplegia ◽

Background Variable ◽

Selective Dorsal Rhizotomy ◽

Gross Motor ◽

Adult Age ◽

Dorsal Rhizotomy ◽

Severe Spasticity

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 causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at four years of age. Variables associated with scoliosis at 20 years of age were explored.MethodIn 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 had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at four years of age were used for stratification.ResultFrequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p=0.004). Frequency of spinal pain did not differ between the groups (p- levels >0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age.ConclusionFrequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.

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