Focal selective dorsal rhizotomy and concurrent deformity correction: a combined approach

Area of Science:

• Neurosurgery
• Pediatric Orthopedics
• Rehabilitation Medicine

Background:

• Cerebral palsy (CP) frequently causes spastic diplegia, impacting motor function.
• Selective Dorsal Rhizotomy (SDR) is a recognized treatment for reducing spasticity in CP.
• Targeting specific motor distributions with focal SDR offers a refined approach.

Purpose of the Study:

• To describe the technique of minimally invasive focal SDR.
• To propose selection criteria for focal SDR.
• To evaluate the efficacy of focal SDR in improving spasticity and gait in children with CP.

Main Methods:

• Retrospective study of 10 pediatric patients with cerebral palsy undergoing focal SDR.
• 3D gait analysis (baseline and 1-year postoperative).
• Modified Ashworth Scale (MAS) and Gait Deviation Index (GDI) as primary outcome measures.

Main Results:

• Focal SDR significantly reduced plantar flexor spasticity (MAS: -2.2, p < 0.001).
• L5 focal SDR improved hamstring spasticity (MAS: -1.4, p = 0.004).
• Mean improvement in Gait Deviation Index (GDI) was 11 points (p < 0.001).

Conclusions:

• Minimally invasive focal SDR, especially when combined with orthopedic interventions, effectively improves spasticity and gait mechanics in select pediatric CP patients.
• The technique shows promise for targeted spasticity management.
• Further research is needed to optimize patient selection and long-term outcomes.