Abstract
Background: Intrathecal baclofen (ITB) administration via an implanted programmable pump and selective dorsal rhizotomy (SDR) are both used for the treatment of cerebral palsy (CP) spasticity.Objective: To examine whether SDR can improve ambulation in children who have been receiving ITB therapy for spastic cerebral palsy.Methods: We reviewed 13 patients who received prior ITB placement with subsequent simultaneous SDR and ITB removal. Patients also completed a follow-up survey to document long-term motor function.Results: In our 13-patient cohort, patients received ITB treatment for an average of 4.4 pm 1.8 years and the mean age of ITB removal/SDR was 12.5 pm 5.8 years. The follow-up period ranged from 3 to 19 months (mean duration: 6.9 pm 5 months). Pre-operatively, all patients had Gross Motor Function Classification System (GMFCS) scores between 2 and 4. Nine patients were diagnosed with spastic diplegia, two had spastic triplegia and two had spastic quadriplegia. SDR and ITB removal led to improved lower limb spasticity and ambulation. GMFCS scores remained stable in all patients. One patient developed a cerebrospinal fluid (CSF) collection in the abdominal wall due to a CSF leak from the baclofen pump site. All 11 patients who completed the follow-up survey noted improved motor function.Conclusion: This study demonstrates that SDR can reduce spasticity and improve mobility after years of ITB treatment for spastic cerebral palsy.
Highlights
Many children with spastic cerebral palsy (CP) receive intrathecal baclofen (ITB) treatment; selective dorsal rhizotomy (SDR) is a newer treatment plan with great promise
We discovered that patients with Gross Motor Function Classification System (GMFCS) levels ll and lll suffered declining ambulatory function during long-term Intrathecal baclofen (ITB) therapy, and the combination of SDR/termination of ITB therapy resulted in qualitative improvements in motor function
Ingale et al found in 10 non-ambulatory spastic CP patients (GMFCS levels lV and V) that SDR was more effective than ITB in reducing spasticity and daily care
Summary
Many children with spastic cerebral palsy (CP) receive intrathecal baclofen (ITB) treatment; selective dorsal rhizotomy (SDR) is a newer treatment plan with great promise. The primary goal of SDR is the removal of spasticity and the improvement of ambulation. Patients and families are under the impression that SDR is not an option when ITB fails to reduce spasticity and improves motor functions. Over the past 11 years, we have treated patients with spastic diplegia and quadriplegia who underwent prior ITB therapy with SDR and simultaneous baclofen pump removal. We report the outcomes for patients receiving ITB and SDR sequentially. Intrathecal baclofen (ITB) administration via an implanted programmable pump and selective dorsal rhizotomy (SDR) are both used for the treatment of cerebral palsy (CP) spasticity
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