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Cerebral palsy spasticity. Selective posterior rhizotomy.
W J Peacock1, L J Arens, B Berman
1Division of Neurosurgery, University of California, Los Angeles.
Pediatric Neuroscience
|January 1, 1987
Summary
Selective posterior rhizotomy improved motor function in children with cerebral palsy (CP). Best outcomes were seen in intelligent, purely spastic patients with lower limb spasticity and some walking ability.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a group of movement disorders affecting muscle tone and posture.
- Spasticity is a common and disabling symptom in children with CP.
- Selective posterior rhizotomy (SPR) is a surgical option to reduce spasticity.
Purpose of the Study:
- To evaluate the effectiveness of selective posterior rhizotomy (SPR) in improving motor function in children with cerebral palsy (CP).
- To identify patient characteristics associated with optimal outcomes after SPR.
Main Methods:
- Selective posterior rhizotomy (SPR) was performed on 60 children with CP.
- The procedure involved lumbar laminectomy and selective division of posterior rootlets based on motor response.
- Patients were assessed pre- and postoperatively for muscle tone, power, functional mobility, and upper limb function over 1-5 years.
Main Results:
- Significant improvements in motor function were observed in a subset of patients post-SPR.
- Patients who benefited most were intelligent, purely spastic, with lower limb-predominant spasticity, and some independent locomotion.
- Children with severe athetosis or contractures showed minimal improvement.
Conclusions:
- Selective posterior rhizotomy (SPR) can be an effective treatment for improving motor function in carefully selected children with cerebral palsy (CP).
- Patient selection is crucial, with purely spastic, intelligent children with lower limb involvement showing the best response.
- SPR is less effective for children with severe athetosis or significant contractures.
