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Selective dorsal rhizotomy for hereditary spastic paraparesis in children
Julia Sharma1, Christopher Bonfield2, Paul Steinbok3,4
1Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
Insights
Selective dorsal rhizotomy (SDR) effectively reduced lower limb spasticity in children with hereditary spastic paraparesis (HSP). However, outcomes were less predictable in complicated HSP cases, suggesting SDR is best for stable conditions.
Area of Science:
- Neurology
- Pediatric Surgery
- Neurosurgery
Background:
- Spasticity in children can stem from spinal cord pathology.
- Selective dorsal rhizotomy (SDR) is a surgical option for spasticity.
- Outcomes of SDR for spinal-related spasticity require further investigation.
Purpose of the Study:
- To evaluate the effectiveness of SDR in treating spasticity caused by spinal pathology in pediatric patients.
- To assess long-term functional outcomes and spasticity scores following SDR.
Main Methods:
- Retrospective review of SDR cases over 30 years.
- Identification of patients with spinal-related spasticity.
- Collection of demographic, functional, and spasticity data pre- and post-operatively.
Main Results:
- Four patients with hereditary spastic paraparesis (HSP) underwent SDR for spinal spasticity.
- All patients experienced sustained reduction in lower limb spasticity.
- Two patients with severe/progressive HSP showed functional decline despite tone improvement.
Conclusions:
- SDR is a viable treatment for uncomplicated HSP-related spasticity.
- Complicated HSP cases treated with SDR have higher risks and less predictable outcomes.
- SDR is most appropriate for spinal pathologies with a stable disease course.
Purpose:
The aim of this study was to determine the outcomes for children who underwent selective dorsal rhizotomy (SDR) for the treatment of spasticity related to spinal pathology.
Methods:
We performed a retrospective review of all cases of SDR at our institution over the last 30 years and identified patients in whom spasticity was attributed to spinal rather than cerebral pathology. We gathered demographic information and recorded functional status and spasticity scores pre-operatively and over long-term follow-up.
Results:
We identified four patients who underwent SDR for spinal-related spasticity. All four had hereditary spastic paraparesis (HSP). All patients had reduced spasticity in the lower limbs after SDR, which was maintained over long-term follow-up. Two patients had a more severe and progressive subtype of HSP, and both these patients exhibited functional decline despite improvement in tone.
Conclusions:
Our findings suggest SDR is a reasonable option to consider for relief of spinal-related spasticity in uncomplicated hereditary spastic paraparesis. However, SDR for the treatment of complicated HSP seems to carry more risks and have a less predictable outcome. Overall, SDR is probably best reserved for pathologies that are relatively stable in their disease course.
