Skip to main content

Advertisement

SpringerLink
Log in

Selective dorsal rhizotomy for hereditary spastic paraparesis in children

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the outcomes for children who underwent selective dorsal rhizotomy (SDR) for the treatment of spasticity related to spinal pathology.

Methods

We performed a retrospective review of all cases of SDR at our institution over the last 30 years and identified patients in whom spasticity was attributed to spinal rather than cerebral pathology. We gathered demographic information and recorded functional status and spasticity scores pre-operatively and over long-term follow-up.

Results

We identified four patients who underwent SDR for spinal-related spasticity. All four had hereditary spastic paraparesis (HSP). All patients had reduced spasticity in the lower limbs after SDR, which was maintained over long-term follow-up. Two patients had a more severe and progressive subtype of HSP, and both these patients exhibited functional decline despite improvement in tone.

Conclusions

Our findings suggest SDR is a reasonable option to consider for relief of spinal-related spasticity in uncomplicated hereditary spastic paraparesis. However, SDR for the treatment of complicated HSP seems to carry more risks and have a less predictable outcome. Overall, SDR is probably best reserved for pathologies that are relatively stable in their disease course.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ailon T, Beauchamp R, Miller S, Mortenson P, Kerr JM, Hengel AR, Steinbok P (2015) Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy. Childs Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 31:415–423

    Article  Google Scholar 

  2. Farmer JP, Sabbagh AJ (2007) Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy. Childs Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 23:991–1002

    Article  Google Scholar 

  3. McLaughlin J, Bjornson K, Temkin N, Steinbok P, Wright V, Reiner A, Roberts T, Drake J, O'Donnell M, Rosenbaum P, Barber J, Ferrel A (2002) Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol 44:17–25

    Article  PubMed  Google Scholar 

  4. Steinbok P (2001) Outcomes after selective dorsal rhizotomy for spastic cerebral palsy. Childs Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 17:1–18

    Article  CAS  Google Scholar 

  5. Gump WC, Mutchnick IS, Moriarty TM (2013) Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria. Neurosurg Focus 35:E6

    Article  PubMed  Google Scholar 

  6. Reynolds RM, Morton RP, Walker ML, Massagli TL, Browd SR (2014) Role of dorsal rhizotomy in spinal cord injury-induced spasticity. J Neurosurg Pediatr 14:266–270

    Article  PubMed  Google Scholar 

  7. Kai M, Yongjie L, Ping Z (2014) Long-term results of selective dorsal rhizotomy for hereditary spastic paraparesis. J Clin Neurosci 21:116–120

    Article  PubMed  Google Scholar 

  8. Ou C, Kent S, Miller S, Steinbok P (2010) Selective dorsal rhizotomy in children: comparison of outcomes after single-level versus multi-level laminectomy technique. Can J Neurosci Nurs 32:17–24

    PubMed  Google Scholar 

  9. Fink JK (2014) Hereditary spastic paraplegia: clinical principles and genetic advances. Semin Neurol 34:293–305

    Article  PubMed  Google Scholar 

  10. Racis L, Tessa A, Pugliatti M, Storti E, Agnetti V, Santorelli FM (2014) Infantile-onset ascending hereditary spastic paralysis: a case report and brief literature review. Eur J Paediatr Neurol: EJPN: Off J Eur Paediatr Neurol Soc 18:235–239

    Article  Google Scholar 

  11. Orrell RW (2005) In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, Bird TD, Fong CT, Mefford HC, Smith RJH, Stephens K (eds) ALS2-related disorders. GeneReviews(R), Seattle

    Google Scholar 

  12. Cole GF, Farmer SE, Roberts A, Stewart C, Patrick JH (2007) Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience. Arch Dis Child 92:781–785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Schijman E, Erro MG, Meana NV (1993) Selective posterior rhizotomy: experience of 30 cases. Childs Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 9:474–477

    Article  CAS  Google Scholar 

  14. Laitinen LV, Nilsson S, Fugl-Meyer AR (1983) Selective posterior rhizotomy for treatment of spasticity. J Neurosurg 58:895–899

    Article  CAS  PubMed  Google Scholar 

  15. Salame K, Ouaknine GE, Rochkind S, Constantini S, Razon N (2003) Surgical treatment of spasticity by selective posterior rhizotomy: 30 years experience. Isr Med Assoc J: IMAJ 5:543–546

    PubMed  Google Scholar 

  16. Yang TF, Lee SS, Lin PH, Chen H, Chan RC (2002) Effect of selective posterior rhizotomy on transverse myelitis in a patient with systemic lupus erythematosus. Am J Phys Med Rehab/Assoc Acad Physiatrists 81:467–468

    Article  Google Scholar 

  17. Park TS (2000) Selective dorsal rhizotomy: an excellent therapeutic option for spastic cerebral palsy. Clin Neurosurg 47:422–439

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada

    Julia Sharma & Paul Steinbok

  2. Vanderbilt University Medical Center, Nashville, USA

    Christopher Bonfield

  3. Division of Pediatric Neurosurgery, British Columbia Children’s Hospital (BCC), 4480 Oak Street, Rm K3-216, Vancouver, BC, V6H 3V4, Canada

    Paul Steinbok

Authors
  1. Julia Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Bonfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul Steinbok
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Steinbok.

Ethics declarations

Ethics approval

The study was approved by the Children’s and Women’s Health Centre of British Columbia Research Ethics Boards, approval number H15-01184.

Conflict of interest

The authors have nothing to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, J., Bonfield, C. & Steinbok, P. Selective dorsal rhizotomy for hereditary spastic paraparesis in children. Childs Nerv Syst 32, 1489–1494 (2016). https://doi.org/10.1007/s00381-016-3122-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-016-3122-2

Keywords

Search

Navigation