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Long-term functional outcome after selective posterior rhizotomy
Sandeep Mittal1, Jean-Pierre Farmer, Borhan Al-Atassi
1Division of Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Quebec, Canada.
Insights
Selective posterior rhizotomy (SPR) significantly improves motor function in children with spastic cerebral palsy (CP). These gains in spasticity, range of motion, and strength persist for at least five years post-surgery.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Selective posterior rhizotomy (SPR) is a surgical intervention for spastic cerebral palsy (CP).
- Long-term quantitative outcome data beyond three years post-SPR are limited.
- Intraoperative electrophysiological monitoring is utilized during SPR.
Purpose of the Study:
- To evaluate the long-term functional outcomes of SPR in children with spastic CP.
- To assess the durability of surgical benefits up to five years post-procedure.
Main Methods:
- Analysis of data from the McGill Rhizotomy Database.
- Inclusion of children with spastic CP undergoing SPR with intraoperative monitoring.
- Quantitative assessments of spasticity, range of motion, strength, and ambulatory function at baseline and 1, 3, and 5 years post-surgery.
Main Results:
- Significant improvements in spasticity, range of motion, and muscle strength were observed at one year, persisting through five years.
- The Gross Motor Function Measure global score improved from 64.6 preoperatively to 85.6 at five years.
- Greatest improvements were noted in lower-extremity motor function, with a 34.4% increase at five years.
Conclusions:
- SPR, with intraoperative stimulation, leads to lasting improvements in lower-limb function for children with spastic CP.
- The surgical procedure effectively alleviates spasticity and enhances motor capabilities long-term.
- The study supports SPR as a valuable treatment for improving functional outcomes in spastic CP.
Object:
Selective posterior rhizotomy (SPR) is a well-recognized treatment for children with spastic cerebral palsy (CP). Few investigators have used quantitative outcome measures to assess the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term functional outcome of children who had undergone selective dorsal rhizotomy accompanied by intraoperative electrophysiological monitoring.
Methods:
The study population was composed of children with spastic CP who underwent SPR and were evaluated by a multidisciplinary team preoperatively, and at 6 months and 1 year postoperatively. Quantitative standardized assessments of lower-limb spasticity, passive range of motion, muscle strength, and ambulatory function were obtained. Of the 93 patients who met the entry criteria for the study, 71 completed the 3-year and 50 completed the 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in spasticity, range of motion, and functional muscle strength at 1 year after SPR. The preoperative, 1-, 3-, and 5-year values for the global score of the Gross Motor Function Measure were 64.6, 70.8, 80, and 85.6, respectively. The greatest improvement occurred in the dimensions reflecting lower-extremity motor function, where the mean change was 10.1% at 1 year, 19.9% at 3 years, and 34.4% at the 5-year follow-up review in comparison with the baseline value. This was associated with a lasting improvement in alignment and postural stability during developmental positions, as well as increased ability to perform difficult transitional movements.
Conclusions:
The results of this study support the presence of significant improvements in lower-limb functional motor outcome 1 year after SPR, and the improvements persist at 3 and 5 years. The authors conclude that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function.