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Selective posterior rhizotomy: a long-term follow-up study
L J Arens1, W J Peacock, J Peter
1Department of Paediatrics, University of Cape Town, South Africa.
Insights
Selective posterior lumbar rhizotomy (SPLR) offers lasting benefits for spastic children, maintaining reduced tone and improving motor function. Early intervention yields the best results, but older children also experience significant functional gains.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Selective posterior lumbar rhizotomy (SPLR) is a surgical procedure aimed at reducing spasticity in children.
- Long-term outcomes and functional improvements following SPLR require further detailed investigation.
- Understanding the impact of age at intervention and adjunct therapies is crucial for optimizing patient results.
Purpose of the Study:
- To re-examine long-term outcomes in spastic children who underwent SPLR.
- To assess the persistence of tone reduction and motor function improvements.
- To explore functional gains in relation to age at surgery and physiotherapy.
Main Methods:
- Longitudinal follow-up study of 51 spastic children who had SPLR between 1981 and 1984.
- Assessment of muscle tone, motor function, and functional gains.
- Evaluation of physiotherapy adherence, sensory disturbances, spinal stability, and outcomes of subsequent orthopedic surgery.
- Parental and patient questionnaires to gauge satisfaction.
Main Results:
- Sustained reduction in muscle tone in all cases.
- Continued motor function improvement in 42 out of 51 children.
- Greatest functional gains observed in children operated on before age 8, with positive outcomes in older children as well.
- Minimal sensory disturbances and no spinal instability reported.
- Positive outcomes from post-rhizotomy orthopedic surgery for contractures.
- High parental and patient satisfaction with the overall results.
Conclusions:
- SPLR is a beneficial intervention for spastic children, providing lasting tone reduction and functional improvements.
- Early surgical intervention (under age 8) is associated with the greatest functional gains.
- Continued physiotherapy, particularly for muscle strengthening, is important for maximizing outcomes.
- Careful patient selection is essential for successful SPLR outcomes.
Abstract:
Fifty-one spastic children who had undergone selective posterior lumbar rhizotomy between 1981 and 1984 were re-examined to determine whether the gains achieved had persisted and to look at other aspects that had not previously been explored in detail. The reduction of tone was maintained in all cases, while motor function continued to improve in 42 cases. Functional gains were greatest in children operated on under the age of 8, but pleasing results were also achieved in older children. Forty-five children continued to receive physiotherapy, particular attention being paid to building up muscle strength. Sensory disturbances were minimal, and there was no evidence of spinal instability. Post-rhizotomy orthopaedic surgery for fixed-joint contractures generally brought further improvement. Parents and older children were also questioned and almost all were enthusiastic about the outcome. Rhizotomy can be of considerable benefit to spastic children, but great care must be taken in the selection of suitable cases.
