Selective Dorsal Rhizotomy for the Treatment of Childhood Spasticity

Abbott, Rick

doi:10.1007/978-3-211-84820-3_88

Cited by 3 publications

(2 citation statements)

References 12 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After electrophysiological checking (lower row: e and f): e Sectioning of three of the four dorsal rootlets with microscissors. f Postsectioning view Ashworth scale: 0 to 4 (from no increase in tone to the rigid limb during flexion/extension) [4,7]; Tardieu scale: 0 to 4 (from no increase in tone to inexhaustible clonus throughout the range of motion) [20,46]; GMFCS = Gross Motor Function Classification System: I to V (from least to most severely affected) [27]; NYU = New York University: I to V (from least to most severely affected) [1][2][3]; Gillette walking scale: 1 to 10 (from cannot take any steps at all to can climb stairs without difficulty) [26] by the surgery. Special attention was paid to eventual deleterious consequences of excessive reduction of spasticity on locomotive power for transfers, standing and walking.…”

Section: Methodsmentioning

confidence: 99%

“…Locomotor evolution was followed on curves established from the Gross Motor Function Measure (GMFM). Patients were categorized according to the severity of their functional locomotor impairment on a grading scale based on the Gross Motor Function Classification System (GMFCS) and the New York University (NYU) scale [1][2][3]27]. Walking ability was measured with the Gillette scale [26].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

Sindou

Georgoulis

2015

Acta Neurochir

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

Sindou

Georgoulis

2015

Acta Neurochir

View full text Add to dashboard Cite

show abstract

Selective Dorsal Rhizotomy

et al. 1993

View full text Add to dashboard Cite

Selective dorsal rhizotomy has shown great promise as a treatment for the functional disabilities and deforming hypertonia of spastic cerebral palsy. At New York University Medical Center, 200 children underwent this procedure between 1986 and 1990. All groups, whether walkers, crawlers, or nonlocomotors, showed improvement in the tone and range of most muscles tested. Half of these patients experienced complications. Thirty-five of these were serious and included bronchospasm (5.5%), aspiration pneumonia (3.5%), urinary retention (7%), and sensory loss (2%). There are, however, clear indications that warn of these complications; monitoring and prophylactic treatment can minimize their effects, and the possibility of such problems is more than offset by the proven benefits of this operative procedure.

show abstract

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

Georgoulis

Brînzeu

Sindou

2018

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

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.

show abstract

Selective Dorsal Rhizotomy for the Treatment of Childhood Spasticity

Cited by 3 publications

References 12 publications

Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy

Selective Dorsal Rhizotomy

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

Contact Info

Product

Resources

About