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Selective dorsal rhizotomy as an alternative to intrathecal baclofen pump replacement in GMFCS grades 4 and 5 children

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Abstract

Background

Conventionally, selective dorsal rhizotomy (SDR) has been reserved for ambulant children and implantation of intrathecal baclofen (ITB) pump for non-ambulant children with cerebral palsy. Rather than replacing the ITB pump in selected Gross Motor Function Classification System (GMFCS) grades 4 and 5 children, we elected to undertake SDR instead. We discuss the rationale and outcomes.

Objectives

To assess if children with severe spasticity treated with long-term ITB pump would benefit from SDR as alternative procedure to replacement of ITB pump.

Method

This study is a prospective review of ten children with severe spasticity. Indications for ITB pump replacement in 3/10 children were previous ITB pump infection and the remaining seven were nearing depletion of drug delivery system. Pre- and post-SDR mean modified Ashworth scores, assessment of urological function and survey of parent/carer satisfaction were undertaken.

Result

Mean Ashworth score reductions post-SDR in the lower limbs and upper limbs were 2.4 and 1.70, respectively. An improvement in urological function was also noticed in 27 % of patients. Overall, 90 % of parents/carers felt that functional outcome with SDR was improved compared with that of ITB.

Conclusion

SDR in comparison to ITB in this subgroup is cheaper, less intrusive by avoiding refills/replacement and found to be more effective than ITB in reducing spasticity and providing ease for nursing care. We therefore suggest that consideration should be given to SDR as an alternative in patients previously implanted with ITB systems complicated by infection or nearing end of battery life.

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Acknowledgments

MV conceived the study. HI and IU wrote the manuscript. HI and SM collated and analysed the data under guidance from MV. The authors received no external sources of support to undertake this investigation.

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Authors and Affiliations

  1. Department of Neurosurgery, Queens Medical Centre, Nottingham, UK

    Harshal Ingale, Ismail Ughratdar, Samiul Muquit, Ahmad A Moussa & Michael H Vloeberghs

  2. Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Harshal Ingale

  3. Department of Neurosurgery, Kings College London, London, UK

    Ismail Ughratdar

  4. Department of Neurosurgery Faculty of Medicine, Assiut University, Asyut, Egypt

    Ahmad A Moussa

Authors
  1. Harshal Ingale
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  2. Ismail Ughratdar
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  3. Samiul Muquit
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  4. Ahmad A Moussa
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  5. Michael H Vloeberghs
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Corresponding author

Correspondence to Harshal Ingale.

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Compliance with ethical standards

Institutional review board approval for notes review was obtained at Nottingham University Hospitals NHS Trust.

Conflict of interest

The authors have no conflicts of interest to declare.

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Ingale, H., Ughratdar, I., Muquit, S. et al. Selective dorsal rhizotomy as an alternative to intrathecal baclofen pump replacement in GMFCS grades 4 and 5 children. Childs Nerv Syst 32, 321–325 (2016). https://doi.org/10.1007/s00381-015-2950-9

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  • DOI: https://doi.org/10.1007/s00381-015-2950-9

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