Neurosurgical treatments for spasticity in children include the traditional selective dorsal rhizotomy (SDR) and intrathecal baclofen pumps (ITBPs), which have been widely used in the past decade as an attractive alternative. The purpose of the study was to examine and compare the outcomes of these two procedures in the treatment of children with severe spasticity.
Materials and methods
A consecutive series of 71 children who underwent SDR for treatment of spasticity was compared with a group of 71 children matched by age and preoperative score on the Gross Motor Function Classification System (GMFCS) who underwent ITBP placement. Change in GMFCS score, lower-extremity tone (based on the Modified Ashworth–Bohannon Scale), and lower-extremity passive range of movement (PROM) at 1 year as well as the need for subsequent orthopedic procedures and parents’ satisfaction were selected as outcome measures.
At 1 year, both SDR and ITBP decreased tone, increased PROM, and improved function. Both procedures resulted in a high degree of patient satisfaction. Compared with ITBP, SDR provided a larger magnitude of improvement in tone (−2.52 vs −1.23, p < 0.0001), PROM (−0.77 vs −0.39, p = 0.0138), and gross motor function (−0.66 vs −0.08, p < 0.0001). In addition, fewer patients in the SDR group required subsequent orthopedic procedures (19.1 vs 40.8%, p = 0.0106).
For children with moderate to severe spasticity, SDR and ITBP are both effective surgical treatments. Our results indicate SDR is more effective in reducing the degree of spasticity and improving function than ITBP is in this group of patients.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Albright AL (1996) Baclofen in the treatment of cerebral palsy. J Child Neurol 11:77–83
Albright AL, Gilmartin R, Swift D, Krach LE, Ivanhoe CB, McLaughlin JF (2003) Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin. J Neurosurg 98:291–295
Armstrong RW, Steinbok P, Cochrane DD, Kube SD, Fife SE, Farrell K (1997) Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg 87:409–414
Engsberg JR, Olree KS, Ross SA, Park TS (1998) Spasticity and strength changes as a function of selective dorsal rhizotomy. J Neurosurg 88:1020–1026
Fasano VA, Urciuoli R, Broggi G, Barolat-Romana G, Benech F, Ivaldi A, Sguazzi A (1977) New aspects in the surgical treatment of cerebral palsy. Acta Neurochir Suppl (Wien) 24:53–57
Gerszten PC, Albright AL, Johnstone GF (1998) Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy. J Neurosurg 88:1009–1013
Giuliani CA (1991) Dorsal rhizotomy for children with cerebral palsy: support for concepts of motor control. Phys Ther 71:248–259
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
Mittal S, Farmer JP, Al-Atassi B, Gibis J, Kennedy E, Galli C, Courchesnes G, Poulin C, Cantin MA, Benaroch TE (2002) Long-term functional outcome after selective posterior rhizotomy. J Neurosurg 97:315–325
Mittal S, Farmer JP, Al-Atassi B, Montpetit K, Gervais N, Poulin C, Benaroch TE, Cantin MA (2002) Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure. J Neurosurg 97:510–518
Müller H, Zierski J, Dralle D (1988) Pharmacokinetics of intrathecal baclofen. In: Müller H, Zierski J, Penn R (eds) Local-spinal therapy of spasticity. Springer, New York, pp 223–226
O’Brien DF, Park TS, Puglisi JA, Collins DR, Leuthardt EC, Leonard JR (2005) Orthopedic surgery after selective dorsal rhizotomy for spastic diplegia in relation to ambulatory status and age. J Neurosurg 103:5–9
Ochs G, Struppler A, Meyerson BA, Linderoth B, Gybels J, Gardner BP, Teddy P, Jamous A, Weinmann P (1989) Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study. J Neurol Neurosurg Psychiatry 52:933–939
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223
Park TS, Owen JH (1992) Surgical management of spastic diplegia in cerebral palsy. N Engl J Med 326:745–749
Peacock WJ, Nuwer MR, Staudt LA (1994) Dorsal rhizotomy: to monitor or not to monitor? J Neurosurg 80:769–772
Penn RD (1992) Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg 77:236–240
Plassat R, Perrouin Verbe B, Menei P, Menegalli D, Mathe JF, Richard I (2004) Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients. Spinal Cord 42:686–693
Rawicki B (1999) Treatment of cerebral origin spasticity with continuous intrathecal baclofen delivered via an implantable pump: long-term follow-up review of 18 patients. J Neurosurg 91:733–736
Sherrington C (1898) Decerebrate rigidity, and reflex coordination of movements. J Physiol 22:319–332
Subramanian N, Vaughan CL, Peter JC, Arens LJ (1998) Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity. J Neurosurg 88:1014–1019
Vanek ZF, Menkes JH (2005) Spasticity. e-Medicine
We thank Kristin Kraus for her editorial assistance in preparing this paper.
About this article
Cite this article
Kan, P., Gooch, J., Amini, A. et al. Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation. Childs Nerv Syst 24, 239–243 (2008). https://doi.org/10.1007/s00381-007-0457-8