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Child's Nervous System

, Volume 35, Issue 11, pp 2171–2178 | Cite as

Feasibility and effectiveness of a newly modified protocol-guided selective dorsal rhizotomy via single-level approach to treat spastic hemiplegia in pediatric cases with cerebral palsy

  • Qijia Zhan
  • Liang Tang
  • Yanyan Wang
  • Bo XiaoEmail author
  • Min Shen
  • Shuyun Jiang
  • Rong Mei
  • Zhibao Lyu
Original Article

Abstract

Purpose

It still remains challenging to treat CP cases with spastic hemiplegia using SDR via a single-level approach when guided by the traditional EMG response grading system. Our aim was to assess the feasibility and effectiveness of a newly modified protocol-guided single-level laminectomy SDR to treat such pediatric patients.

Methods

A retrospective cohort review was conducted in the CP cases with spastic hemiplegia undergone our newly modified protocol-guided single-level approach SDR since May 2016 to October 2017, and followed by intensive rehabilitation program for at least 12 months in both Shanghai Children’s Hospital and Shanghai Rehabilitation and Vocational Training Center for the Disabled. Inclusion and exclusion criteria were set for the selection of patients in the current study. Our study focused on the setup, EMG recording interpretation, and outcome measures for this newly modified rhizotomy scheme.

Results

Eleven cases were included in the current study. Based on our new rhizotomy protocol, a total of 34 rootlets over our 11 cases were cut (2 in 4, 3 in 4, 4 in 1, and 5 rootlets in 2 cases, respectively). After SDR and the following rehabilitation program at a mean duration of 19 months, muscle tone of those “target muscles” in affected lower extremities which identified during pre-op assessment decreased by a mean of 1.4 degrees (Modified Ashworth Scale) in our cases. Strength of those target muscles and ROM of joints involved in their lower limbs were reported to have improved significantly as well. All cases showed major progress with regard to their motor function. A mean of about 10-point increase of GMFM-66 score was reported, and five of six cases who were with GMFCS level II preoperatively improved their GMFCS level at the last assessment. Kinematics of joints of hip, knee, and ankle on the affected side in our cases demonstrated a major correction, along with improvement of their foot pressure patterns to the ground during their gait cycles. Surgery-related complications, such as cerebral–spinal fluid leak/infection, long-term hypoesthesia, or urinary/bowel incontinence were not recorded in the current study.

Conclusion

Single-level SDR when guided by our simplified rhizotomy protocol is feasible and effective to treat pediatric CP cases with spastic hemiplegia.

Keywords

Simplified rhizotomy scheme EMG response interpretation Outcome measures Comparison 

Notes

Compliance with ethical standards

Conflict of interest

None.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Qijia Zhan
    • 1
  • Liang Tang
    • 2
  • Yanyan Wang
    • 1
  • Bo Xiao
    • 1
    Email author
  • Min Shen
    • 3
  • Shuyun Jiang
    • 4
  • Rong Mei
    • 1
  • Zhibao Lyu
    • 5
  1. 1.Department of Neurosurgery, Shanghai Children’s HospitalShanghai Jiao Tong UniversityShanghaiChina
  2. 2.Rehabilitation Center, Shanghai Children’s HospitalShanghai Jiao Tong UniversityShanghaiChina
  3. 3.Rehabilitation CenterShanghai Rehabilitation and Vocational Training Center for the DisabledShanghaiChina
  4. 4.Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
  5. 5.Department of General Surgery, Shanghai Children’s HospitalShanghai Jiao Tong UniversityShanghaiChina

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