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[Lumbar structural observation of children with cerebral palsy after selective posterior rhizotomy]
1Orthopaedic Neurology Unit, People's Hospital, Peking University, Beijing 100034, China.
Insights
Selective posterior rhizotomy (SPR) in children with cerebral palsy did not significantly alter lumbar spine stability. However, younger children showed better healing of excised laminae, while older children had higher rates of spondylolysis and spondylolisthesis.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Neurosurgery
Context:
- Spastic cerebral palsy (CP) affects motor function, often necessitating surgical interventions.
- Selective posterior rhizotomy (SPR) is a surgical procedure to reduce spasticity in CP.
- Lumbar spine stability and vertebral healing after SPR are critical considerations for long-term outcomes.
Purpose:
- To evaluate the impact of SPR on lumbar spine stability in children with CP.
- To assess the regenerative capacity of excised laminae following SPR.
- To correlate age and ambulatory status with postoperative spinal changes.
Summary:
- A study of 179 children with CP undergoing SPR analyzed pre- and postoperative lumbar spine stability using X-rays.
- Results indicated no significant changes in lumbar stability across age and ambulatory groups post-SPR.
- Younger children (<10 years) demonstrated osteous healing of excised laminae, while older children showed increased incidence of spondylolysis and spondylolisthesis.
Impact:
- Findings suggest SPR is safe concerning lumbar spine stability in pediatric CP patients.
- The study highlights age-dependent differences in vertebral healing and potential risks of spinal pathologies after SPR.
- This research informs surgical decision-making and postoperative monitoring strategies for children with CP undergoing SPR.
Objective:
To investigate the stability of lumbar column after selective posterior rhizotomy and to observe the healing of exscinded laminae.
Methods:
One hundred and seventy nine children with spastic cerebral palsy were divided into four groups (A, B, C, D) according to the age (< 10 years or > or = 10 years) and walking ability (ambulatory or unable to walk) and were operated on by selective posterior rhizotomy (SPR). Lumbar X-ray films, both standing and lying position, and orthotopic and lateral dynamic lumbar films were taken pre- and postoperatively. Lumbosacral angle, Cobb's angle in lateral position, and AO/W, RO/W of dynamic films were recorded and analyzed according to Posner's definition. Regeneration of exscinded laminae was observed.
Results:
(1) The lumbosacral angle, Cobb's angle, and other indicators in the ambulatory group (A + C) were not significantly varied pre- and postoperatively; (2) The lumbo-sacral angle, Cobb's angle, and other indicators in the groups unable to walk independently (B + D groups) were varied significantly. (3) Nine cases of scoliosis (with the Cobb's angle of 18 degrees-35 degrees) were found in the group of 10 years younger (9.38%); (4) Six cases of spondylolysis (7.23%, with Cobb's angle of 15 degrees-25 degrees) and 5 cases of spondylolisthesis (6.58%) were found in the group of 10 years older. (5) Osteous healing of sectioned laminae was found in the group of age younger than 10 years, especially in the young children. (6) Stability of lumbar vertebrae were not significantly varied pre- and post-operatively among all groups.
Conclusion:
The exscinded laminae of children after SPR have the healing ability. The stability of lumbar column was not significant varied pre- and postoperatively.