Assessment of the long-term effect of selective brachial plexus rhizotomy in the treatment of spastic cerebral palsy

Abstract

Objective To evaluate the long-term effect of selective brachial plexus rhizotomy in the treatment of spastic cerebral palsy. Methods Twenty-one patients（22 sides） who had undergone selective brachial plexus rhizotomy due to upper extremity spastic cerebral palsy from March 1997 to January 2002 were followed-up. Based on the Lazareff muscular tension criteria, their clinical effect was evaluated. Then the factors relatedto the clinical effect were analyzed. Results Sixteen patients （ 17 sides） had sufficient follow-up. Their mean age at surgery was 18 years old and their mean follow-up time was 8.6 years ranging from 5 to 9.7 years. Ten patients had selective whale-root rhizotomy of the brachial plexus, 2 had selective partial-root rhizotomy and 5 had highly-selective nerve-tract rhizotomy. C6 rhizotomy was carried out in 3 sides and C8 rhizotomy in 16 sides. The long-term effect was rated as excellent in 3 patients, effective in 5 patients and ineffective in 8 patients（9 sides）. Conclusion The long-term effect of selective brachial plexus rhizotomy for treatment of upper extremity spastic cerebral palsy was generally poor. However, Good effect can still be obtained if highly-selective nerve-tract rhizotomy was carried out in those whose muscle spasm was localized and who had long-term and strict postoperative functional rehabilitation. Key words: Brachial plexus; Cerebral palsy; Muscle spasm; Follow-up studies; Selective posterior rhizotomy