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Selective posterior rhizotomy in children with cerebral palsy: a 10-year experience
1Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
Insights
Selective Posterior Rhizotomy (SPR) effectively reduces spasticity in children with cerebral palsy, leading to significant functional improvements. Age and preoperative mobility are key predictors of successful long-term outcomes.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by spasticity, impacting motor function.
- Selective Posterior Rhizotomy (SPR) is a surgical procedure aimed at reducing spasticity in CP patients.
- A comprehensive understanding of SPR's long-term efficacy and safety profile is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate the 10-year surgical outcomes of Selective Posterior Rhizotomy (SPR).
- To assess improvements in functional ability and identify adverse effects following SPR.
- To determine predictive factors for postoperative functional gains in spastic children with cerebral palsy.
Main Methods:
- Retrospective review of 208 patients who underwent SPR between 1990 and 1999.
- Assessment of spasticity, passive range of motion, gait pattern, and functional ability pre- and post-operatively.
- Analysis of patient age and preoperative ambulatory functional level as predictive factors.
Main Results:
- Over 95% of patients experienced overall improvement in spasticity, passive range of motion, and gait.
- Preoperative ambulatory functional level and age were significant predictors of postoperative functional improvement.
- Older children, compared to younger ones, had pre-existing limitations in range of motion that persisted post-surgery.
- Most complications, including hypotonia and urinary retention, were temporary and functionally insignificant.
Conclusions:
- Selective Posterior Rhizotomy (SPR) is an effective surgical intervention for alleviating spasticity in children with cerebral palsy.
- SPR offers lasting functional benefits with an acceptable level of temporary complications.
- Patient selection based on age and preoperative functional status is important for optimizing SPR outcomes.
Abstract:
We reviewed our 10-year experience of selective posterior rhizotomy (SPR), with an emphasis on surgical outcome concentrated on improvements in functional ability and adverse effects. We had performed SPR in 208 patients between 1990 and 1999. All patients showed an overall improvement (over 95%) in spasticity, passive range of motion, and gait pattern. Preoperative ambulatory functional level and age were very important predictive factors for further improvements in postoperative functional ability. Compared with the younger children, the older ones lacked a full range of motion preoperatively, and they continued to lack a full range of motion postoperatively, despite the decrease in tone achieved by SPR. Most postoperative complications such as hypotonia, urinary retention, spinal deformities, and sensory changes were temporary and not functionally important. We conclude that SPR is an effective method of alleviating spasticity and provides lasting functional benefits at acceptable complication levels in spastic children with cerebral palsy.