Abstract
Objective To investigate the effectiveness and safety of cervical selective posterior rhizotomy(SPR) and replacement laminoplasty (RL) for children with spastic cerebral palsy (SCP) in upper limbs. Methods A retrospective study was conducted on 47 children cases of SCP in upper limbs enrolled into Department of Functional Neurosurgery, Beijing Children′s Hospital, Capital Medical University from June 2015 to May 2017. Twenty-one cases among them underwent SPR+ RL by using ultrasonic bone-cutting knife combined with rehabilitation (surgery-rehabilitation group) and the rest 26 cases received merely rehabilitation (rehabilitation group). Three-dimensional CT of cervical vertebra was re-examined for imaging evaluation. The modified Melbourne assessment (MMA) of unilateral upper limb function and modified Ashworth scale (MAS) were used for clinical evaluation. Results At the follow-up after 8 months of treatment, the spasticity and motor function of upper limbs in all cases were improved, and no one was going with serious postoperative complications including instability of cervical vertebra. The means of scale scores before treatment and after 8-month treatment in rehabilitation group were as follows: MMA: 0.54±0.19 vs. 0.66±0.19 (t=2.28, P=0.03) and MAS: 5.48±0.65 vs. 4.92±0.56 (t=-3.33, P 0.05), while it was statistically significant after 8-month treatment (MMA: t=3.54, P<0.01; MAS: t=-5.38, P<0.01). The bone fusion rate in surgery-rehabilitation group was C5: 76.2% (16 cases), C6: 85.7% (18 cases), C7: 90.5% (19 cases) and T1: 81.0% (17 cases). The bone fusion rate of C5-T1 was 83.3%. Conclusions Using ultrasound bone-cutting knife in laminectomy followed by RL could optimize the operation process, increase the bone fusion rate in vertebral reduction and reduce the risk of cervical instability postoperatively. SPR+ RL combined with rehabilitation therapy seems more effective than merely rehabilitation therapy for SCP children in upper limbs. Key words: Cerebral palsy; Muscle spasticity; Rhizotomy; Replacement laminoplasty; Piezosurgery
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