Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

Grunt, Sebastian; Becher, Jules G.; Vermeulen, R. Jeroen

doi:10.1111/j.1469-8749.2011.03912.x

Cited by 90 publications

(58 citation statements)

References 39 publications

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“…Judicious intraoperative EMG monitoring is a widely performed and evidence-based approach and used to mitigate against severe lower limb weakness and incontinence (36). The literature suggests that in the long term, patients may experience increased lordosis and hip subluxation (6,32,37,38), but there is insufficient evidence to attribute the complications to SDR or the natural history of CP (30). However, the single-level laminectomy aims to significantly reduce the likelihood and severity of these complications (11).…”

Section: Outcome Of Sdrmentioning

confidence: 99%

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Graham¹,

Aquilina²,

Cawker³

et al. 2016

J. Spine Surg.

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The management of cerebral palsy (CP) is complex and requires a multidisciplinary approach. Selective dorsal rhizotomy (SDR) is a neurosurgical technique that aims to reduce spasticity in the lower limbs.A minimally invasive approach to SDR involves a single level laminectomy at the conus and utilises intraoperative electromyography (EMG). When combined with physiotherapy, SDR is effective in selected children and has minimal complications. This review discusses the epidemiology of CP and the management using SDR within an integrated multidisciplinary centre. Particular attention is given to the single-level laminectomy technique of SDR and its rationale, and the patient workup, recovery and outcomes of SDR.

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Section: Outcome Of Sdrmentioning

confidence: 99%

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Graham¹,

Aquilina²,

Cawker³

et al. 2016

J. Spine Surg.

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“…In their review of long-term adverse effects of SDR, Grunt et al 25 reported that back pain and spinal abnormalities were common, including kyphosis, scoliosis, lumbar lordosis, spondylosis and spondylolisthesis. But they found insufficient evidence to conclude such abnormalities are the direct result of SDR rather than related to the natural history of spastic CP.…”

Section: Outcomes Of Selective Dorsal Rhizotomymentioning

confidence: 99%

Selective dorsal rhizotomy: an old treatment re-emerging

2015

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Selective dorsal rhizotomy (SDR) is a neurosurgical technique developed to reduce spasticity and improve mobility in children with cerebral palsy (CP) and lower extremity spasticity. It involves the selective division of lumbosacral afferent (sensory) rootlets at the conus or at the intervertebral foramina under intraoperative neurophysiological guidance. First described in 1908, early procedures were effective at reducing spasticity but were associated with significant morbidity. Technical advancements over the last two decades have reduced the invasiveness of the procedure, typically from a five-level laminoplasty to a single-level laminotomy at the conus. As practised today, SDR is an effective treatment for young patients with bilateral spastic CP who are rigorously selected for surgery and for whom realistic objectives are set. SDR has therefore re-emerged as a valuable management option for spastic CP. In this article, the authors review the single-level SDR technique and its role in the management of bilateral spastic CP, with particular emphasis on patient selection and outcomes.

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“…Intrathecal baclofen pump insertion,16 selective dorsal rhizotomy17 and deep brain stimulation18 are all available at highly specialist centres in the UK. Detailed assessment and patient selection is essential and there needs to be clear communication between the specialist centre and all other multidisciplinary teams involved with the child and family to ensure close monitoring and follow-up is maintained (see table 4).…”

Section: Clinical Carementioning

confidence: 99%

Fifteen-minute consultation: Modern-day art and science of managing cerebral palsy

Cadwgan

Goodwin

Fairhurst

2018

Arch Dis Child Educ Pract Ed

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While there remains limited intervention to address the damage to the developing brain, current multidisciplinary management of cerebral palsy (CP) needs to minimise the impact of secondary musculoskeletal complications. A focus on comorbidities to maximise function for activity and participation by supporting the child and family in their environment is required. Comprehensive clinical guidance was published by National Institute for Health and Care Excellence (NICE) earlier this year. This article aims to provide a practical clinical approach to the child and family based on:(1) art: empathy, listening and weighing up the clinical picture of the child and family in context; diagnosis, the need for support and space; and care coordination at the right time; and (2) science: the current science in CP care is rapidly expanding in terms of plasticity, pathophysiology, functional assessments and treatments.

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Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

Abstract: There is lack of evidence concerning the long-term outcomes after SDR. Future studies need to clarify the long-term influence of SDR - especially in the ICF domains of activity and participation.

Cited by 90 publications

References 39 publications

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Selective dorsal rhizotomy: an old treatment re-emerging

Fifteen-minute consultation: Modern-day art and science of managing cerebral palsy

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