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Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation

Child's Nervous System volume 24, pages 239–243 (2008)Cite this article

Abstract

Introduction

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.

Results

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).

Conclusions

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.

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Acknowledgments

We thank Kristin Kraus for her editorial assistance in preparing this paper.

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Authors and Affiliations

  1. Departments of Neurosurgery and Physical Medicine and Rehabilitation, Primary Children’s Medical Center, University of Utah, Salt Lake City, UT, USA

    Peter Kan, Judith Gooch, Aminullah Amini, Diana Ploeger, Barbara Grams, Wende Oberg, Sara Simonsen, Marion Walker & John Kestle

  2. Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children’s Medical Center, University of Utah, 100 N. Medical Drive, Salt Lake City, UT, 84113, USA

    John Kestle

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  1. Peter Kan
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  2. Judith Gooch
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  3. Aminullah Amini
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  4. Diana Ploeger
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  7. Sara Simonsen
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  8. Marion Walker
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  9. John Kestle
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Correspondence to John Kestle.

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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

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  • DOI: https://doi.org/10.1007/s00381-007-0457-8

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