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Long-term outcome after selective posterior rhizotomy in children with spastic cerebral palsy
S M Gul1, P Steinbok, K McLeod
1Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Selective posterior rhizotomy (SPR) surgery improved spasticity and motor function in children with spastic cerebral palsy (CP). These positive outcomes for lower limb spasticity were maintained five years after the procedure.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy (CP) significantly impacts children's motor function.
- Selective posterior rhizotomy (SPR) is a surgical option for managing spasticity in CP.
- Long-term outcomes of SPR require further investigation.
Purpose of the Study:
- To evaluate the long-term effectiveness of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP).
- To assess changes in lower limb spasticity, range of motion, muscle strength, and ambulatory function up to 5 years post-SPR.
Main Methods:
- Retrospective analysis of prospectively collected data from children with spastic CP who underwent SPR.
- Quantitative assessments included Ashworth scale for spasticity, goniometry for range of motion, and MRC scale for muscle strength.
- Primary outcome measures were hip adductor spasticity, hip abduction range of motion, and quadriceps strength at 1 and 5 years post-surgery.
Main Results:
- 33 out of 80 eligible patients completed 5-year follow-up.
- Significant improvements in spasticity, range of motion, and muscle strength were observed at both 1 and 5 years post-SPR.
- Hip adductor spasticity decreased from 4.1 to 2.1 (1 year) and 2.2 (5 years).
- Hip abduction range of motion increased from 20.4° to 39.9° (1 year) and 31.7° (5 years).
- Quadriceps strength improved from 3.6 to 4.0 (1 year) and 4.1 (5 years).
Conclusions:
- Lumbosacral SPR provides significant improvements in lower limb motor outcomes for children with spastic CP.
- These functional improvements are evident at 1 year and generally sustained at 5 years post-surgery.
- SPR is an effective intervention for long-term management of spasticity and functional deficits in pediatric CP.
Abstract:
A retrospective analysis of data collected prospectively was performed to determine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population comprised children with spastic CP, who had SPR more than 4 years prior to the time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically, muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the same measures. Hip adductor spasticity, hip abduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entry criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-year values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2.1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and quadriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed to be better at 1 and 5 years compared to baseline, but no statistical analysis was done for this secondary outcome measure. It was concluded that improvements in lower limb motor outcome are present at 1 year after SPR, and that these improvements are generally maintained at 5 years.