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Selective dorsal rhizotomy as a treatment option for children with spastic cerebral palsy
1Department of Biomedical Engineering, University of Cape Town, Observatory, Western Cape 7925, South Africa
Insights
Selective dorsal rhizotomy effectively reduces spasticity in children with cerebral palsy, offering lasting functional improvements in gait and range of motion. This neurosurgical option provides significant benefits for managing this common childhood motor disorder.
Area of Science:
- Neurology
- Pediatric Orthopedics
- Neurosurgery
Background:
- Cerebral palsy (CP) is the leading childhood motor disability, with spasticity being its most common symptom.
- Current treatments for CP spasticity include physiotherapy, medications, and surgery, with selective dorsal rhizotomy (SDR) gaining prominence.
- Despite its use, the efficacy of SDR remains a subject of discussion.
Purpose of the Study:
- To provide a comprehensive review of cerebral palsy, its treatments, and the role of selective dorsal rhizotomy.
- To evaluate the clinical outcomes and functional benefits of SDR in managing spasticity and gait abnormalities in CP.
- To analyze gait analysis data to assess the long-term impact of SDR.
Main Methods:
- Review of literature on cerebral palsy classification and treatment modalities.
- Detailed examination of selective dorsal rhizotomy, including patient selection, surgical procedure, and complication analysis.
- Analysis of gait studies focusing on temporal-distance parameters and joint kinematics.
Main Results:
- Selective dorsal rhizotomy demonstrates significant short-term (1 year) and long-term (10 years) reduction in spasticity.
- Functional benefits, including improved range of motion during gait, are sustained over the long term following SDR.
- Gait analysis confirms lasting positive effects on motor function.
Conclusions:
- Selective dorsal rhizotomy is a valuable neurosurgical treatment option for children with spastic diplegia cerebral palsy.
- SDR offers lasting functional improvements beyond just spasticity reduction.
- While not a universal cure, SDR is an important consideration for clinicians managing CP.
Abstract:
Cerebral palsy is the most common motor disorder originating in childhood and spasticity is the most frequent manifestation. The treatment strategies to reduce spasticity and thereby ameliorate the attendant gait abnormalities have included physiotherapy, orthoses, antispastic medications, orthopaedic surgery and neurosurgery. Of these, the neurosurgical procedure known as selective dorsal rhizotomy has gained widespread exposure, and indeed acceptance, over the past two decades, despite there being some controversy as to its efficacy. In this paper we review: cerebral palsy, including classification and treatment; selective dorsal rhizotomy, including historical background, patient selection, operative procedure, clinical outcome and complications; and gait analysis studies, including temporal-distance parameters, joint kinematics, normalisation for growth, and long-term follow-up. Both the short-term (1 year) and long-term (10 years) evidence has demonstrated that selective dorsal rhizotomy not only reduces spasticity but it also provides lasting functional benefits as measured by improved range of motion during gait. Rhizotomy is not a panacea for children with spastic diplegia but it is an important treatment option for the clinician to consider. Copyright 1998 Elsevier Science B.V.
