Evidence Supporting Selective Dorsal Rhizotomy for Treatment of Spastic Cerebral Palsy.

Ts Park,Matthew B Dobbs,Junsang Cho

doi:10.7759/cureus.3466

Ts Park, Matthew B Dobbs + Show 1 more

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https://doi.org/10.7759/cureus.3466

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Journal: Cureus	Publication Date: Oct 19, 2018
Citations: 26	License type: cc-by

Affiliation: St. Louis Children's Hospital, Neurological Surgery

Abstract

The objective of this review is to analyze the evidence supporting selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy (CP). We reviewed 85 outcome studies from 12 countries between 1990 and 2017. The published results are overwhelmingly supportive of SDR, and 39 studies form a basis for this review. Also included is some of the clinical experience of the senior author.The results show that SDR plus postoperative physiotherapy (PT) improved gait, functional independence, and self-care in children with spastic diplegia. In adults with a follow-up of 20 to 28 years, the early improvements after childhood SDR were sustained and improved quality of life. Furthermore, majority of the adults who underwent SDR as children would recommend SDR to others. On the clinical side, while SDRs through multilevel laminectomies or laminoplasty were associated with spinal deformities (i.e., scoliosis, hyperlordosis, kyphosis, spondylolisthesis, spondylolysis, and nonhealing of laminoplasty), SDRs through a single level laminectomy prevented SDR-related spinal problems. The outcomes of SDR specific to spastic quadriplegia require further investigation because of the relatively small patient population with quadriplegia. Lastly, we found that SDR can prevent or reverse premature aging in adolescents and adults with spastic diplegia. In conclusion, the evidence supporting the efficacy of SDR is strong, and SDR is a well-established option for spasticity management in spastic CP.

Highlights

BackgroundIn the last 30 years, selective dorsal rhizotomy (SDR) endured the test of time as a surgical treatment plan for spastic cerebral palsy (CP) patients as many countries have adopted the neurosurgical procedure
The results show that SDR plus postoperative physiotherapy (PT) improved gait, functional independence, and self-care in children with spastic diplegia
In 2013, the National Health Service in England issued a policy statement, “There is moderate quality evidence that SDR plus physiotherapy in children resulted in significant improvement in spasticity and gross motor function over the 12-month follow-up” [2]

Summary

Introduction

In the last 30 years, selective dorsal rhizotomy (SDR) endured the test of time as a surgical treatment plan for spastic cerebral palsy (CP) patients as many countries have adopted the neurosurgical procedure. We examined orthopedic surgery after SDR in relation to ambulatory status and age at SDR in spastic diplegia for 158 diplegic child patients [18]. They were grouped into independent or assisted walkers, and the follow-up period was five to nine years. We learned that children with mild spastic diplegia lose motor functions after seven to ten years of age Those who walk independently in early childhood reported deteriorated motor function, which requires them to use a device to assist in walking as adults. The major complications occurred in 0.3% of patients

Conclusions

Disclosures

Findings

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