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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

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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.

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References

  1. Graham D, Aquilina K, Cawker S, Paget S, Wimalasundera N (2016) Single-level selective dorsal rhizotomy for spastic cerebral palsy. J Spine Surg 2:195–201. https://doi.org/10.21037/jss.2016.08.08

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fasano VA, Broggi G, Zeme S (1988) Intraoperative electrical stimulation for functional posterior rhizotomy. Scand J Rehabil Med Suppl 17:149–154

    CAS  PubMed  Google Scholar 

  3. Steinbok P, Kestle JR (1996) Variation between centers in electrophysiologic techniques used in lumbosacral selective dorsal rhizotomy for spastic cerebral palsy. Pediatr Neurosurg 25:233–239. https://doi.org/10.1159/000121131

    Article  CAS  PubMed  Google Scholar 

  4. Turner RP (2009) Neurophysiologic intraoperative monitoring during selective dorsal rhizotomy. J Clin Neurophysiol 26:82–84. https://doi.org/10.1097/WNP.0b013e31819f9077

    Article  PubMed  Google Scholar 

  5. Georgoulis G, Brînzeu A, Sindou M (2018) Dorsal rhizotomy for children with spastic diplegia of cerebral palsy origin: usefulness of intraoperative monitoring. J Neurosurg Pediatr 22(1):89–101. https://doi.org/10.3171/2018.1.PEDS17577

    Article  PubMed  Google Scholar 

  6. Fasano VA, Broggi G, Barolat-Romana G, Sguazzi A (1978) Surgical treatment of spasticity in cerebral palsy. Childs Brain 4:289–305

    CAS  PubMed  Google Scholar 

  7. Peacock WJ, Arens LJ (1982) Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J 62:119–124

    CAS  PubMed  Google Scholar 

  8. Park TS, Gaffney PE, Kaufman BA, Molleston MC (1993) Selective lumbosacral dorsal rhizotomy immediately caudal to the conus medullaris for cerebral palsy spasticity. Neurosurgery 33:929–933. https://doi.org/10.1097/00006123-199311000-00026

    Article  CAS  PubMed  Google Scholar 

  9. Park TS, Johnston JM (2006) Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Neurosurg Focus 21:1–6

    Google Scholar 

  10. Bales J, Apkon S, Osorio M, Kinney G, Robison RA, Hooper E, Browd S (2016) Infra-conus single-level laminectomy for selective dorsal rhizotomy: technical advance. Pediatr Neurosurg 51:284–291. https://doi.org/10.1159/000448046

    Article  PubMed  Google Scholar 

  11. Kothbauer KF, Deletis V (2010) Intraoperative neurophysiology of the conus medullaris and cauda equine. Childs Nerv Syst 26:247–253. https://doi.org/10.1007/s00381-009-1020-6

    Article  PubMed  Google Scholar 

  12. Arens LJ, Peacock WJ, Peter J (1989) Selective posterior rhizotomy: a long-term follow-up study. Childs Nerv Syst 5:148–152

    Article  CAS  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. Dudley RW, Parolin M, Gagnon B, Saluja R, Yap R, Montpetit K, Ruck J, Poulin C, Cantin MA, Benaroch TE, Farmer JP (2013) Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatr 12:142–150. https://doi.org/10.3171/2013.4.PEDS12539

    Article  PubMed  Google Scholar 

  15. Josenby AL, Wagner P, Jarnlo GB, Westbom L, Nordmark E (2012) Motor function after selective dorsal rhizotomy: a 10-year practice-based follow-up study. Dev Med Child Neurol 54:429–435. https://doi.org/10.1111/j.1469-8749.2012.04258.x

    Article  PubMed  Google Scholar 

  16. Munger ME, Aldahondo N, Krach LE, Novacheck TF, Schwartz MH (2017) Long-term outcomes after selective dorsal rhizotomy: a retrospective matched cohort study. Dev Med Child Neurol 59:1196–1203. https://doi.org/10.1111/dmcn.13500

    Article  PubMed  Google Scholar 

  17. Nordmark E, Josenby AL, Lagergren J, Andersson G, Strömblad LG, Westbom L (2008) Long-term outcomes five years after selective dorsal rhizotomy. BMC Pediatr 8(54). https://doi.org/10.1186/1471-2431-8-54

  18. Bolster EA, van Schie PE, Becher JG, van Ouwerkerk WJ, Strijers RL, Vermeulen RJ (2013) Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Dev Med Child Neurol 55:610–616. https://doi.org/10.1111/dmcn.12148

    Article  PubMed  Google Scholar 

  19. Romei M, Oudenhoven LM, van Schie PEM, van Ouwerkerk WJR, van der Krogt MM, Buizer AI (2018) Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: a 10 year follow-up study. Gait Posture 64:108–113. https://doi.org/10.1016/j.gaitpost.2018.06.002

    Article  PubMed  Google Scholar 

  20. Grunt S, Henneman WJ, Bakker MJ, Harlaar J, van der Ouwerkerk WJ, van Schie P, Reeuwijk A, Becher JG, Vermeulen RJ (2010) Effect of selective dorsal rhizotomy on gait in children with bilateral spastic paresis: kinematic and EMG-pattern changes. Neuropediatrics 41:209–216. https://doi.org/10.1055/s-0030-1267983

    Article  CAS  PubMed  Google Scholar 

  21. Oudenhoven LM, van der Krogt MM, Romei M, van Schie PEM, van de Pol LA, van Ouwerkerk WJR, Harlaar J, Buizer AI (2018) Factors associated with long-term improvement of gait after selective dorsal rhizotomy. Arch Phys Med Rehabil 100:474–480. https://doi.org/10.1016/j.apmr.2018.06.016

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, 355 Luding Rd, Shanghai, China

    Qijia Zhan, Yanyan Wang, Bo Xiao & Rong Mei

  2. Rehabilitation Center, Shanghai Children’s Hospital, Shanghai Jiao Tong University, 355 Luding Rd, Shanghai, China

    Liang Tang

  3. Rehabilitation Center, Shanghai Rehabilitation and Vocational Training Center for the Disabled, 265 Linyi North Rd, Shanghai, China

    Min Shen

  4. Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai, China

    Shuyun Jiang

  5. Department of General Surgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, 355 Luding Rd, Shanghai, China

    Zhibao Lyu

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  1. Qijia Zhan
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  2. Liang Tang
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  4. Bo Xiao
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  5. Min Shen
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Correspondence to Bo Xiao.

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Zhan, Q., Tang, L., Wang, Y. et al. 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. Childs Nerv Syst 35, 2171–2178 (2019). https://doi.org/10.1007/s00381-019-04194-0

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