Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

Sindou, Marc; Georgoulis, George

doi:10.1007/s00701-015-2453-1

Cited by 31 publications

(26 citation statements)

References 36 publications

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“…According to the International Classification of Functioning Disabilities and Health (ICF), [5] the aim of any rehabilitation approach is to restore and improve the patient involvement in the functional activities of daily living. In this process, many interventions are available, such as rhizotomy, [6] intrathecal baclofen pump, [7] surgery, [8,9] etc., which have been employed previously with certain degree of success. However, these therapies have several limitations and drawbacks and the treatment provided does not last for a longer duration of time.…”

Section: Introductionmentioning

confidence: 99%

Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

Gupta

Rajak

Bhatia

et al. 2016

Journal of Medical Engineering & Technology

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Spastic cerebral palsy (CP) is the one of most common neurological disorders occurring due to damage to the immature brain or any other brain lesion at the time of birth. To aid in making the life of the CP patient meaningful, several interventions such as medical, surgical and rehabilitation have been employed to date. Besides these, recently repetitive Transcranial magnetic stimulation (r-TMS) is a new found approach which is being employed for treating various neurological and psychological conditions. The aim of this study was to observe the effects of r-TMS on muscle spasticity in CP patients by stimulating the motor cortex area of the brain, which is responsible for muscle movements. In this study, 20 subjects diagnosed with CP were recruited and 10 each were placed in two groups, namely the research group (RG) (mean age, height and weight were 7.99 (SD = 4.66) years, 116.7 (SD = 23.57) cm and 21.40 (SD = 10.95) kg, respectively) and the control group (CG) (mean age, height and weight were 8.41 (SD = 4.32) years, 107.9 (SD = 26.33) cm, 21.40 (SD = 12.63) kg, respectively). r-TMS frequencies of 5 Hz and 10 Hz were administered for 15 min daily to patients in RG followed by standard therapy (ST) of 1 h duration daily for 20 days. Moreover, the patients in the control group (CG) were given only standard therapy (ST) of 1 h duration for 20 days. Modified Ashworth Scale (MAS) was used as an outcome measure to determine the level of muscle spasticity. A pre- assessment of MAS score was performed on both RG and CG to determine the level of spasticity prior to starting therapy; and similarly post-assessment after 20 days was done to observe the changes post-therapy. Statistical analysis of pre vs post MAS scores showed that few muscles showed reduction in muscle tightness after administering only ST in the CG. On the contrary, the RG that underwent r-TMS therapy combined with ST showed a significant decrease (p < 0.05) in muscle tightness for all the muscles selected for the therapy.

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Section: Introductionmentioning

confidence: 99%

Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

Gupta

Rajak

Bhatia

et al. 2016

Journal of Medical Engineering & Technology

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“…Marc Sindou from Lyon, France, agreed with the technique of cauda equina exposure to identify the nerve at the exit foramina but was concerned about the long segment exposure required by the Peacock technique (L2-S2). Sindou and Georgoulis [42] then developed the Keyhole interlaminar dorsal rhizotomy (KIDr) technique in 2014, which allows them minimal spinal ligamentous injury, while still allowing accurate nerve root identification at the exit foraminae. Currently, this center performs all their SDR's using this approach [42].…”

Section: Modern Sdrmentioning

confidence: 99%

“…Sindou and Georgoulis [42] then developed the Keyhole interlaminar dorsal rhizotomy (KIDr) technique in 2014, which allows them minimal spinal ligamentous injury, while still allowing accurate nerve root identification at the exit foraminae. Currently, this center performs all their SDR's using this approach [42]. They have also done away with a whole spine plaster cast for 6 weeks, as done before, in using this technique.…”

Section: Modern Sdrmentioning

confidence: 99%

The Evolution of Selective Dorsal Rhizotomy for the Management of Spasticity

2019

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Selective dorsal rhizotomy is a key technique in the surgical management of spasticity in patients with cerebral palsy. The technique evolved from the late 1800s when pioneers like Dana and Abbe performed dorsal rhizotomy in their treatment of refractory pain. These surgeons noted a reduction in muscle tone associated with the operation. When Sherrington then published his Nobel prize-winning work on the corticospinal tract and its role in the neuromuscular system in the 1890s, the course was set for modifying spasticity by aiming surgery at the dorsal roots. This procedure underwent multiple modifications through the next century and today it is, arguably, the most commonly performed operation to treat cerebral palsy children with spasticity. Selective dorsal rhizotomy is a technique that still teaches us a great deal about neurophysiology on a daily basis and it is thanks to the pioneers, described in this article, that we have this tool in our armamentarium.

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“…The main criterion for the decision to perform surgery, and for its timing, was the regression in the Gross Motor Function Measure score. 38,41,42 For the children able to walk, the goal was to improve ambulation and gait and prevent contractures. For the nonambulatory children, the aim was to ease care, improve comfort, and stop the evolution of deformities.…”

Section: Patient Selectionmentioning

confidence: 99%

“…The surgical approach was the modality that we have previously published under the name of keyhole interlaminar dorsal rhizotomy (KIDr). 41 In brief, the method is based on the creation of 2-3 enlarged midline interlaminar (IL) openings ( Fig. 2B), whose number and level are decided individually for each patient on the basis of the preoperative chart, as illustrated in the schematic drawing of Fig.…”

Section: Surgical Approachmentioning

confidence: 99%

Dorsal rhizotomy for children with spastic diplegia of cerebral palsy origin: usefulness of intraoperative monitoring

Georgoulis

Brînzeu

Sindou

2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe utility of intraoperative neuromonitoring (ION), namely the study of muscle responses to radicular stimulation, remains controversial. The authors performed a prospective study combining ventral root (VR) stimulation for mapping anatomical levels and dorsal root (DR) stimulation as physiological testing of metameric excitability. The purpose was to evaluate to what extent the intraoperative data led to modifications in the initial decisions for surgical sectioning established by the pediatric multidisciplinary team (i.e., preoperative chart), and thus estimate its practical usefulness.METHODSThirteen children with spastic diplegia underwent the following surgical protocol. First, a bilateral intradural approach was made to the L2–S2 VRs and DRs at the exit from or entry to their respective dural sheaths, through multilevel interlaminar enlarged openings. Second, stimulation—just above the threshold—of the VR at 2 Hz to establish topography of radicular myotome distribution, and then of the DR at 50 Hz as an excitability test of root circuitry, with independent identification of muscle responses by the physiotherapist and by electromyographic recordings. The study aimed to compare the final amounts of root sectioning—per radicular level, established after intraoperative neuromonitoring guidance—with those determined by the multidisciplinary team in the presurgical chart.RESULTSThe use of ION resulted in differences in the final percentage of root sectioning for all root levels. The root levels corresponding to the upper lumbar segments were modestly excitable under DR stimulation, whereas progressively lower root levels displayed higher excitability. The difference between root levels was highly significant, as evaluated by electromyography (p = 0.00004) as well as by the physiotherapist (p = 0.00001). Modifications were decided in 11 of the 13 patients (84%), and the mean absolute difference in the percentage of sectioning quantity per radicular level was 8.4% for L-2 (p = 0.004), 6.4% for L-3 (p = 0.0004), 19.6% for L-4 (p = 0.00003), 16.5% for L-5 (p = 0.00006), and 3.2% for S-1 roots (p = 0.016). Decreases were most frequently decided for roots L-2 and L-3, whereas increases most frequently involved roots L-4 and L-5, with the largest changes in terms of percentage of sectioning.CONCLUSIONSThe use of ION during dorsal rhizotomy led to modifications regarding which DRs to section and to what extent. This was especially true for L-4 and L-5 roots, which are known to be involved in antigravity and pelvic stability functions. In this series, ION contributed significantly to further adjust the patient-tailored dorsal rhizotomy procedure to the clinical presentation and the therapeutic goals of each patient.

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Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

Cited by 31 publications

References 36 publications

Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients

The Evolution of Selective Dorsal Rhizotomy for the Management of Spasticity

Dorsal rhizotomy for children with spastic diplegia of cerebral palsy origin: usefulness of intraoperative monitoring

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