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Simultaneous Selective Dorsal Rhizotomy and Baclofen Pump Removal Improve Ambulation in Patients with Spastic
T S Park1, Brandon A Miller1, Junsang Cho1
1Neurological Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, USA.
Insights
Selective dorsal rhizotomy (SDR) can improve mobility and reduce spasticity in children with cerebral palsy (CP) who have previously undergone intrathecal baclofen (ITB) therapy.
Area of Science:
- Neurology
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Intrathecal baclofen (ITB) therapy and selective dorsal rhizotomy (SDR) are established treatments for spasticity in cerebral palsy (CP).
- The efficacy of SDR in children previously treated with ITB requires further investigation.
Purpose of the Study:
- To evaluate the impact of SDR on ambulation in children with spastic cerebral palsy who had previously received ITB therapy.
Main Methods:
- A retrospective review of 13 patients who underwent SDR with simultaneous ITB removal after prior ITB treatment.
- Patients' long-term motor function was assessed via a follow-up survey.
Main Results:
- Following SDR and ITB removal, patients experienced improved lower limb spasticity and enhanced ambulation.
- Gross Motor Function Classification System (GMFCS) scores remained stable across all patients.
- All surveyed patients reported improvements in motor function, with one case of cerebrospinal fluid (CSF) collection.
Conclusions:
- Selective dorsal rhizotomy is a viable option for improving spasticity and mobility in children with cerebral palsy after long-term ITB treatment.
- SDR can be safely performed in conjunction with ITB removal, offering significant functional benefits.
Background:
Intrathecal baclofen (ITB) administration via an implanted programmable pump and selective dorsal rhizotomy (SDR) are both used for the treatment of cerebral palsy (CP) spasticity.
Objective:
To examine whether SDR can improve ambulation in children who have been receiving ITB therapy for spastic cerebral palsy.
Methods:
We reviewed 13 patients who received prior ITB placement with subsequent simultaneous SDR and ITB removal. Patients also completed a follow-up survey to document long-term motor function.
Results:
In our 13-patient cohort, patients received ITB treatment for an average of 4.4 [Formula: see text] 1.8 years and the mean age of ITB removal/SDR was 12.5 [Formula: see text] 5.8 years. The follow-up period ranged from 3 to 19 months (mean duration: 6.9 [Formula: see text] 5 months). Pre-operatively, all patients had Gross Motor Function Classification System (GMFCS) scores between 2 and 4. Nine patients were diagnosed with spastic diplegia, two had spastic triplegia and two had spastic quadriplegia. SDR and ITB removal led to improved lower limb spasticity and ambulation. GMFCS scores remained stable in all patients. One patient developed a cerebrospinal fluid (CSF) collection in the abdominal wall due to a CSF leak from the baclofen pump site. All 11 patients who completed the follow-up survey noted improved motor function.
Conclusion:
This study demonstrates that SDR can reduce spasticity and improve mobility after years of ITB treatment for spastic cerebral palsy.
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