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Selective posterior rhizotomy for children with cerebral palsy: a 7-year experience
T Nishida1, S W Thatcher, G R Marty
1Department of Neurology, Northwestern University Medical School, Chicago, IL 60611, USA.
Insights
Selective Posterior Rhizotomy (SPR) effectively treats spastic cerebral palsy. This study details a 7-year experience, outlining patient selection, surgical techniques, and functional outcomes for improved mobility and self-care.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Selective Posterior Rhizotomy (SPR) is increasingly used for cerebral palsy spasticity.
- Surgical techniques and understanding of SPR are continually evolving.
- This paper reviews 7 years of clinical experience with SPR.
Purpose of the Study:
- To outline a protocol for patient selection and surgical technique in SPR for spastic cerebral palsy.
- To report functional outcomes and long-term results of SPR.
- To provide guidance for clinicians considering SPR.
Main Methods:
- Preoperative evaluation by a multidisciplinary team to determine SPR candidacy.
- Detailed description of the SPR surgical procedure, including intraoperative nerve root stimulation.
- Review and comparison of historical and current nerve stimulation protocols.
Main Results:
- Reported outcomes include improvements in joint range of motion, self-care tasks, and ambulation.
- Analysis of functional goals in relation to postoperative evaluation and therapy.
- Experience-based insights into optimizing SPR outcomes.
Conclusions:
- SPR is a viable treatment option for spastic cerebral palsy with demonstrated functional benefits.
- A structured approach to patient selection and surgical technique is crucial for successful SPR outcomes.
- This experience can guide clinicians in establishing SPR protocols and managing patient expectations.
Abstract:
Although selective posterior rhizotomy (SPR) was pioneered as early as 1913, only over the past decade has the procedure gained popular use for the treatment of spasticity in cerebral palsy. The medical knowledge base regarding this procedure is expanding, and surgical techniques continue to be revised. We present our 7 years of experience in treating spastic cerebral palsy using SPR. The aspects of preoperative evaluation used by the multidisciplinary team to determine candidacy are outlined. The surgical procedure is detailed with a particular emphasis on the role of intraoperative nerve root stimulation to aid in selection for rootlet sectioning. Historical nerve stimulation protocols are reviewed and compared to our findings over the years. The functional goals are discussed in the context of the postoperative evaluation and therapies. Specific outcome in relation to joint range of motion, self care tasks, and ambulation is reported. The paper outlines a concise overview of our experiences and will assist the clinician in defining a protocol and expectations for SPR.