Focal selective dorsal rhizotomy and concurrent deformity correction: a combined approach.

Autor:	Gadgil N; 1Department of Surgery, Division of Neurosurgery, Texas Children's Hospital/Baylor College of Medicine, Houston., Schwabe AL; 2Department of Surgery, Division of Physical Medicine and Rehabilitation, Texas Children's Hospital/Baylor College of Medicine, Houston., Wright E; 2Department of Surgery, Division of Physical Medicine and Rehabilitation, Texas Children's Hospital/Baylor College of Medicine, Houston., Barbuto A; 3Department of Physical and Occupational Therapy, Texas Children's Hospital, Houston; and., Dugan EL; 4Department of Surgery, Division of Orthopedic Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas., Thomas SP; 2Department of Surgery, Division of Physical Medicine and Rehabilitation, Texas Children's Hospital/Baylor College of Medicine, Houston., Shilt JS; 4Department of Surgery, Division of Orthopedic Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas., Beauvais D; 4Department of Surgery, Division of Orthopedic Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas., Shih Y; 4Department of Surgery, Division of Orthopedic Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas., Smith BG; 4Department of Surgery, Division of Orthopedic Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas., Bauer DF; 1Department of Surgery, Division of Neurosurgery, Texas Children's Hospital/Baylor College of Medicine, Houston., Curry DJ; 1Department of Surgery, Division of Neurosurgery, Texas Children's Hospital/Baylor College of Medicine, Houston.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2024 Jun 14; Vol. 34 (3), pp. 278-285. Date of Electronic Publication: 2024 Jun 14 (Print Publication: 2024).
DOI:	10.3171/2024.4.PEDS2432
Abstrakt:	Objective: Selective dorsal rhizotomy (SDR) is a neurosurgical procedure to reduce spasticity in children with cerebral palsy and spastic diplegia. The authors developed a procedure called focal SDR for children with spasticity predominantly in the L5 or S1 motor distribution, which can be combined with orthopedic correction of fixed soft-tissue or bony deformity. The authors describe in detail the technique of minimally invasive focal SDR and propose selection criteria. Methods: The authors conducted a retrospective study of patients who underwent focal SDR at their institution and underwent baseline and 1-year postoperative 3D gait analysis. Modified Ashworth scale (MAS) and Gait Deviation Index (GDI) scores were the primary outcome measures. Results: Ten patients met the study criteria, all with an underlying diagnosis of cerebral palsy. All underwent focal SDR at the unilateral or bilateral S1 level, and 4 additionally underwent focal SDR at the L5 level unilaterally or bilaterally. All but 1 patient underwent concurrent orthopedic surgery. The improvement in spasticity of the plantar flexors, as measured by the MAS score, was 2.2 (p < 0.001). In the patients who underwent L5 focal SDR, there was an improvement in the hamstring MAS score of 1.4 (p = 0.004). The mean improvement in the GDI score following focal SDR was 11 (range -6 to 29, p < 0.001). Conclusions: Focally impairing spasticity in the gastrocsoleus complex and/or hamstrings muscle group in the setting of less functionally impactful proximal tone is extremely common in cerebral palsy. The novel technique of focal SDR, combined with orthopedic intervention, improves spasticity scores and overall gait mechanics. Further investigation is warranted to define the ideal candidacy and outcomes.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu