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Combined Selective Dorsal Rhizotomy and Single-Event Multilevel Surgery in a Child with Spastic Diplegic Cerebral
Kayli Gimarc1, Suzanne Yandow2, Samuel Browd3
1Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Insights
This case report details a combined selective dorsal rhizotomy (SDR) and single-event multilevel surgery (SEMLS) for a child with spastic diplegic cerebral palsy (CP). The combined procedure successfully resolved spasticity and improved range of motion and functional mobility.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Spastic diplegic cerebral palsy (CP) presents challenges in gait and function due to spasticity and limited range of motion (ROM).
- Selective dorsal rhizotomy (SDR) addresses spasticity, while single-event multilevel surgery (SEMLS) targets functional gait impairments.
- This report introduces the first known case of combined SDR and SEMLS in a pediatric patient with spastic diplegic CP.
Observation:
- A 7-year-old GMFCS level II spastic diplegic CP patient with bilateral lower extremity spasticity and contractures underwent combined SDR/SEMLS.
- Initial postoperative assessment revealed increased lower extremity weakness and functional decline, necessitating intensive rehabilitation.
- The patient experienced persistent genu recurvatum and knee instability requiring prolonged physical therapy.
Findings:
- Postoperative follow-up demonstrated resolution of spasticity and significant improvement in ROM.
- The Gross Motor Function Measure-66 improved from 62.1 (35th percentile) preoperatively to 68.9 (55th percentile) at 12 months.
- By 30 months, the patient achieved functional gains, enabling participation in recreational activities.
Implications:
- Combined SDR/SEMLS offers a potential strategy for simultaneously managing spasticity, contractures, and gait impairments in select pediatric CP patients.
- This approach may reduce the need for multiple surgical interventions.
- Multidisciplinary teams should consider this combined surgical option for carefully selected individuals with spastic CP.
Introduction:
Children with spastic diplegic cerebral palsy (CP) often have functional and gait impairments related to spasticity and loss of range of motion (ROM). Selective dorsal rhizotomy (SDR) and single-event multilevel surgery (SEMLS) are surgical interventions that are used to manage spasticity and functional gait impairments, respectively. This is the first known case report of a child with spastic diplegic CP who underwent combined SDR and SEMLS.
Case Report:
Our patient is a 7-year-old girl with spastic diplegic CP, functioning at the Gross Motor Function Classification System (GMFCS) level II, who presented with spasticity and contractures in bilateral lower extremities leading to functional gait impairments, despite conservative management. Combined SDR/SEMLS was offered with the goal of simultaneously managing spasticity and contractures while reducing the need for multiple procedures. Postoperatively, the patient's functional mobility, ROM, spasticity, and strength were assessed at various follow-up intervals. The patient had increased lower extremity weakness and functional decline postoperatively. Persistent genu recurvatum and knee instability required prolonged rehabilitation services, and she demonstrated functional gains with these interventions. At follow-ups, spasticity was resolved and ROM improved. By the 12-month follow-up, the Gross Motor Function Measure-66 was improved to 68.9 (55th percentile) from the preoperative level of 62.1 (35th percentile). By the 30-month follow-up, she was able to participate in novel recreational activities.
Discussion/Conclusion:
Multidisciplinary teams may consider combined SDR/SEMLS for management of spasticity, gait impairment, and contracture in carefully selected patients with spastic CP.
