Long-term functional outcome after selective posterior rhizotomy
| Autor: | Chantal Poulin, Borhan Al-Atassi, Jean Pierre Farmer, Marie André Cantin, Sandeep Mittal, Guylaine Courchesnes, Eileen Kennedy, Thierry E. Benaroch, Carlo Galli, Joanne Gibis |
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| Rok vydání: | 2002 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Neurological disorder Motor Activity Rhizotomy Cerebral palsy Spastic cerebral palsy Monitoring Intraoperative Outcome Assessment Health Care medicine Spastic Humans Prospective Studies Spasticity Range of Motion Articular Child Muscle Skeletal Leg business.industry Cerebral Palsy Recovery of Function medicine.disease Surgery Electrophysiology Posterior Horn Cells Child Preschool Anesthesia Ambulatory Female medicine.symptom Range of motion business |
| Zdroj: | Journal of Neurosurgery. 97:315-325 |
| ISSN: | 0022-3085 |
| DOI: | 10.3171/jns.2002.97.2.0315 |
| Popis: | Object. Selective posterior rhizotomy (SPR) is a well-recognized treatment for children with spastic cerebral palsy (CP). Few investigators have used quantitative outcome measures to assess the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term functional outcome of children who had undergone selective dorsal rhizotomy accompanied by intraoperative electrophysiological monitoring. Methods. The study population was composed of children with spastic CP who underwent SPR and were evaluated by a multidisciplinary team preoperatively, and at 6 months and 1 year postoperatively. Quantitative standardized assessments of lower-limb spasticity, passive range of motion, muscle strength, and ambulatory function were obtained. Of the 93 patients who met the entry criteria for the study, 71 completed the 3-year and 50 completed the 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in spasticity, range of motion, and functional muscle strength at 1 year after SPR. The preoperative, 1-, 3-, and 5-year values for the global score of the Gross Motor Function Measure were 64.6, 70.8, 80, and 85.6, respectively. The greatest improvement occurred in the dimensions reflecting lower-extremity motor function, where the mean change was 10.1% at 1 year, 19.9% at 3 years, and 34.4% at the 5-year follow-up review in comparison with the baseline value. This was associated with a lasting improvement in alignment and postural stability during developmental positions, as well as increased ability to perform difficult transitional movements. Conclusions. The results of this study support the presence of significant improvements in lower-limb functional motor outcome 1 year after SPR, and the improvements persist at 3 and 5 years. The authors conclude that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function. |
| Databáze: | OpenAIRE |
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