Effect of selective dorsal rhizotomy on daily care and comfort in non-walking children and adolescents with severe spasticity

Abstract Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery increases the risk for later spine problems. Using CP-registry data from a geographically defined population with the same health care and habilitation services, the objectives were to compare reported scoliosis and spinal pain up to adult age in all SDR-operated with all non-SDR-operated individuals with same medical history, functional abilities, and level of spasticity at four years of age. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990-2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at four years of age and were included; 36 persons had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 individuals constituting the control group, had not. Data on scoliosis and spinal pain at 10, 15, 20 and 25 years of age were analyzed using Kaplan-Meier survival curves and Fisher’s exact test. Gross motor function classification (GMFCS) levels at four years of age (or pre-operatively) were used for stratification.Result Presence of scoliosis at 15, 20, and 25 years of age was the same in the SDR group as in the control group (p=0.734, 0.735 and 1.0). In severe functional disability (GMFCS IV), the SDR group had later onset and lower occurrence of scoliosis (p=0.004) than the control group. Frequency of reported spinal pain did not differ between the groups. Conclusion Neither scoliosis, nor spinal pain was more frequent after SDR than expected by natural history. On the contrary, in severe CP (GMFCS level IV), scoliosis was less frequently reported and had a later onset in the SDR group than in the same GMFCS-level control group.

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Erratum: Risk Factors for Dystonia after Selective Dorsal Rhizotomy in Nonwalking Children and Adolescents with Bilateral Spasticity

Neuropediatrics ◽

10.1055/s-0037-1613692 ◽

2017 ◽

Vol 49 (01) ◽

pp. e1-e1

Author(s):

Laura van de Pol ◽

R. Vermeulen ◽

Charlotte van 't Westende ◽

Petra van Schie ◽

Eline Bolster ◽

...

Keyword(s):

Risk Factors ◽

Children And Adolescents ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy

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Risk Factors for Dystonia after Selective Dorsal Rhizotomy in Nonwalking Children and Adolescents with Bilateral Spasticity

Neuropediatrics ◽

10.1055/s-0037-1607395 ◽

2017 ◽

Vol 49 (01) ◽

pp. 044-050 ◽

Cited By ~ 3

Author(s):

R. Vermeulen ◽

Charlotte van 't Westende ◽

Petra van Schie ◽

Eline Bolster ◽

Pim van Ouwerkerk ◽

...

Keyword(s):

Risk Factors ◽

Children And Adolescents ◽

Clinical Evidence ◽

Brain Mri ◽

Congenital Disorder ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Chi Squared ◽

Selection Of Patients ◽

Selection Of

AbstractWe recently showed a beneficial effect of selective dorsal rhizotomy (SDR) on daily care and comfort in nonwalking children with severe bilateral spasticity. However, despite careful selection, some patients showed dystonia after the intervention, in which cases caregivers tended to be less satisfied with the result.The aim of this study is to identify risk factors for dystonia after SDR in children and adolescents with severe bilateral spasticity (GMFCS levels IV/V).Clinical and MRI risk factors for dystonia after SDR were studied in our cohort of 24 patients. Patients with clinical evidence of dystonia and brain MRI showing basal ganglia abnormalities were excluded for SDR.Nine of 24 patients (38%) showed some degree of dystonia after SDR. There was a significant association between the cause of spasticity and dystonia after SDR; in six (67%) patients with a congenital disorder, dystonia was present versus three (20%) with an acquired disorder (Chi-squared test: C(1) = 5.23, p = 0.02).This study allows more optimal selection of patients that may benefit from SDR. Patients with an acquired cause of spasticity, when selected carefully on clinical examination and MRI, rarely show dystonia after SDR. However, patients with an underlying congenital disorder have a considerable risk of dystonia after SDR.

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No Support that Early Selective Dorsal Rhizotomy Increase Frequency of Scoliosis and Spinal Pain – a longitudinal population-based register study from four to 25 years of age

10.21203/rs.3.rs-35375/v2 ◽

2020 ◽

Author(s):

Annika Lundkvist Josenby ◽

Lena Westbom

Keyword(s):

Logistic Regression ◽

Motor Development ◽

Spinal Pain ◽

Spastic Diplegia ◽

Background Variable ◽

Selective Dorsal Rhizotomy ◽

Gross Motor ◽

Adult Age ◽

Dorsal Rhizotomy ◽

Severe Spasticity

Abstract Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at four years of age. Variables associated with scoliosis at 20 years of age were explored.MethodIn the total population with CP spastic diplegia in Skåne and Blekinge, born 1990-2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at four years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at four years of age were used for stratification.ResultFrequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p=0.004). Frequency of spinal pain did not differ between the groups (p- levels >0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age.ConclusionFrequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.

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No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain – a longitudinal population-based register study from four to 25 years of age

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03782-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Annika Lundkvist Josenby ◽

Lena Westbom

Keyword(s):

Logistic Regression ◽

Motor Development ◽

Spinal Pain ◽

Spastic Diplegia ◽

Background Variable ◽

Selective Dorsal Rhizotomy ◽

Gross Motor ◽

Adult Age ◽

Dorsal Rhizotomy ◽

Severe Spasticity

Abstract Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at 4 years of age. Variables associated with scoliosis at 20 years of age were explored. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990–2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at 4 years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5–6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at 4 years of age were used for stratification. Result Frequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p = 0.004). Frequency of spinal pain did not differ between the groups (p- levels > 0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age. Conclusion Frequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.

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Muscle Tone Assessment under General Anesthesia for Sjögren-Larsson Syndrome and Spasticity

Pediatric Neurosurgery ◽

10.1159/000514329 ◽

2021 ◽

Vol 56 (2) ◽

pp. 163-165

Author(s):

George Georgoulis ◽

Argyrios Dinopoulos ◽

Emmanouil Gkliatis

Keyword(s):

General Anesthesia ◽

Muscle Tone ◽

Muscle Relaxants ◽

Spastic Diplegia ◽

Case Presentation ◽

Neurosurgical Procedure ◽

Dorsal Rhizotomy ◽

Severe Spasticity ◽

Larsson Syndrome ◽

Rule Out

Introduction: Study of muscle tone in individuals with severe spasticity (Modified Asworth Scale – MAS:3) under general anesthesia can confirm or rule out the eventual necessity of the impending spasticity relieving ablative neurosurgery by observing the hypertonia reduction and passive range of motion expansion. Therefore, what we measure under muscle relaxants is practically a fixed deformity. Case Presentation: The study was performed on a girl with Sjögren-Larsson syndrome, presenting with icthyosis and spastic diplegia. Proposed intervention was Dorsal Rhizotomy. Under general anesthesia, with and without muscle relaxants, hypertonia was significantly reduced (MAS:1), but the angle of motion did not increase much. Conclusion: We decided not to perform such a neurosurgical procedure. In ambiguous situations, the proposed study can help in decision-making for spasticity treatment.

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The effect of GMFCS level, age, sex, and dystonia on multi-dimensional outcomes after selective dorsal rhizotomy: prospective observational study

Child s Nervous System ◽

10.1007/s00381-021-05076-0 ◽

2021 ◽

Vol 37 (5) ◽

pp. 1729-1740

Author(s):

Conor Scott Gillespie ◽

◽

Alan Matthew George ◽

Benjamin Hall ◽

Steven Toh ◽

...

Keyword(s):

Motor Function ◽

Self Care ◽

Pediatric Neurosurgery ◽

Care Quality ◽

Fine Motor ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Significant Difference ◽

Age Category ◽

Gmfcs Level

Abstract Purpose Investigate the effect of age category (1–9 years vs 10–18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR). Methods Prospective, single-center study of all children aged 3–18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes. Results From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05–7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively). Conclusion SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.

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