Urodynamic Findings in Pediatric Spastic Cerebral Palsy: Retrospective Study From a Single Center

Objective To investigate the urodynamic study (UDS) result in pediatric patients with spastic cerebral palsy (CP). Material and methods Medical records of CP with pre-operative UDS results underwent selective dorsal rhizotomy (SDR) from Jan. 2020 to May. 2021 were retrospectively reviewed. Results Fifty-seven cases with spastic CP were included in the study. Among these cases, 46 were ambulatory and 11 were non-ambulatory. Average gross motor function measure - 66 (GMFM - 66) score was 62.16 ± 11.39. Reduced bladder capacity was seen in 49.12% of these cases and cases with lower GMFM - 66 score had a higher incidence rate of having low bladder capacity (p < 0.01). Detrusor overactivity (DO) was shown in 33.33% of patients. Cases with younger age had higher prevalence of DO (p < 0.05). Meanwhile, more non-ambulant patients had DO (p < 0.05). Increased post-voiding residual (PVR) was seen in 21.05% of cases. Those with higher average threshold in sphincter-associated input spinal nerve roots (rootlets) had higher rate of having abnormal PVR (p < 0.05). Conclusion Abnormal UDS results were prevalent in pediatric spastic CP. Motor function, age and threshold of their sphincter-associated spinal nerve rootlets were related to the abnormal UDS results.

Correction of hip joint instability in children with cerebral palsy — current state of the problem and prospects for its solution (literature REVIEW)

Hip instability in children with cerebral palsy (CP) is a serious unresolved problem in modern orthopedics. Objective. To analyze the state of the problem of the hip joint instability in children with cerebral palsy and determine the prospects for its solution. Me­thods. A thematic review of 68 studies was made. Results. The basis for the prevention of instability of the hip joint should be a systema­tic X-ray screening at least once a year. The instability of the hip joint is based on neurological disorders, if the index of migration of the femoral head (MP) is less than 30 %, the application of selective dorsal rhizotomy or baclofen pump is promising and justified. If MP > 30–100 % dorsal rhizotomy can be used after surgical correction of abnormalities in the hip joint to reduce the recurrence rate. The existing surgeries on the pelvic and femur is sufficient to restore the stability of this joint, even in the most severe cases, but the result is not always possible to maintain due to the recurrence of the deformity. The requirement for hip intervention in a patient with cerebral palsy is a preventive focus, by which we mean not only the achievement of joint stability, but also the creation of conditions for its preservation. Temporary blockage of the medial portion of the femoral head growth area is a minimally invasive procedure and may be recommended for use alone or as an adjunct to hip soft tissue release or for hip and bone surgery. However, it is still unclear at what age it is better to block the growth plate of the femoral head, whether and how often to change the clamps and so on. A prerequisite for the treatment of patients with this pathology is an individual approach, taking into account the degree of displacement of the femoral head, the presence of pathology of adjacent joints, the age of the child and the severity of the disease. Correction of existing deviations should be performed in one step at many levels.