Cargando…

Long-term outcomes five years after selective dorsal rhizotomy

BACKGROUND: Selective dorsal rhizotomy (SDR) is a well accepted neurosurgical procedure performed for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP). The goal is to improve function, but long-term outcome studies are rare. The aims of this study...

Descripción completa

Detalles Bibliográficos
Autores principales: Nordmark, Eva, Josenby, Annika Lundkvist, Lagergren, Jan, Andersson, Gert, Strömblad, Lars-Göran, Westbom, Lena
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633339/
https://www.ncbi.nlm.nih.gov/pubmed/19077294
http://dx.doi.org/10.1186/1471-2431-8-54
_version_ 1782164107000020992
author Nordmark, Eva
Josenby, Annika Lundkvist
Lagergren, Jan
Andersson, Gert
Strömblad, Lars-Göran
Westbom, Lena
author_facet Nordmark, Eva
Josenby, Annika Lundkvist
Lagergren, Jan
Andersson, Gert
Strömblad, Lars-Göran
Westbom, Lena
author_sort Nordmark, Eva
collection PubMed
description BACKGROUND: Selective dorsal rhizotomy (SDR) is a well accepted neurosurgical procedure performed for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP). The goal is to improve function, but long-term outcome studies are rare. The aims of this study were to evaluate long-term functional outcomes, safety and side effects during five postoperative years in all children with diplegia undergoing SDR combined with physiotherapy. METHODS: This study group consisted of 35 children, consecutively operated, with spastic diplegia, of which 26 were Gross Motor Function Classification System (GMFCS) levels III–V. Mean age was 4.5 years (range 2.5–6.6). They were all assessed by the same multidisciplinary team at pre- and at 6, 12, 18 months, 3 and 5 years postoperatively. Clinical and demographic data, complications and number of rootlets cut were prospectively registered. Deep tendon reflexes and muscle tone were examined, the latter graded with the modified Ashworth scale. Passive range of motion (PROM) was measured with a goniometer. Motor function was classified according to the GMFCS and measured with the Gross Motor Function Measure (GMFM-88) and derived into GMFM-66. Parent's opinions about the children's performance of skills and activities and the amount of caregiver assistance were measured with Pediatric Evaluation Disability Inventory (PEDI). RESULTS: The mean proportion of rootlets cut in S2-L2 was 40%. Muscle tone was immediately reduced in adductors, hamstrings and dorsiflexors (p < 0.001) with no recurrence of spasticity over the 5 years. For GMFCS-subgroups I–II, III and IV–V significant improvements during the five years were seen in PROM for hip abduction, popliteal angle and ankle dorsiflexion (p = 0.001), capacity of gross motor function (GMFM) (p = 0.001), performance of functional skills and independence in self-care and mobility (PEDI) (p = 0.001). CONCLUSION: SDR is a safe and effective method for reducing spasticity permanently without major negative side effects. In combination with physiotherapy, in a group of carefully selected and systematically followed young children with spastic diplegia, it provides lasting functional benefits over a period of at least five years postoperatively.
format Text
id pubmed-2633339
institution National Center for Biotechnology Information
language English
publishDate 2008
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-26333392009-01-31 Long-term outcomes five years after selective dorsal rhizotomy Nordmark, Eva Josenby, Annika Lundkvist Lagergren, Jan Andersson, Gert Strömblad, Lars-Göran Westbom, Lena BMC Pediatr Research Article BACKGROUND: Selective dorsal rhizotomy (SDR) is a well accepted neurosurgical procedure performed for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP). The goal is to improve function, but long-term outcome studies are rare. The aims of this study were to evaluate long-term functional outcomes, safety and side effects during five postoperative years in all children with diplegia undergoing SDR combined with physiotherapy. METHODS: This study group consisted of 35 children, consecutively operated, with spastic diplegia, of which 26 were Gross Motor Function Classification System (GMFCS) levels III–V. Mean age was 4.5 years (range 2.5–6.6). They were all assessed by the same multidisciplinary team at pre- and at 6, 12, 18 months, 3 and 5 years postoperatively. Clinical and demographic data, complications and number of rootlets cut were prospectively registered. Deep tendon reflexes and muscle tone were examined, the latter graded with the modified Ashworth scale. Passive range of motion (PROM) was measured with a goniometer. Motor function was classified according to the GMFCS and measured with the Gross Motor Function Measure (GMFM-88) and derived into GMFM-66. Parent's opinions about the children's performance of skills and activities and the amount of caregiver assistance were measured with Pediatric Evaluation Disability Inventory (PEDI). RESULTS: The mean proportion of rootlets cut in S2-L2 was 40%. Muscle tone was immediately reduced in adductors, hamstrings and dorsiflexors (p < 0.001) with no recurrence of spasticity over the 5 years. For GMFCS-subgroups I–II, III and IV–V significant improvements during the five years were seen in PROM for hip abduction, popliteal angle and ankle dorsiflexion (p = 0.001), capacity of gross motor function (GMFM) (p = 0.001), performance of functional skills and independence in self-care and mobility (PEDI) (p = 0.001). CONCLUSION: SDR is a safe and effective method for reducing spasticity permanently without major negative side effects. In combination with physiotherapy, in a group of carefully selected and systematically followed young children with spastic diplegia, it provides lasting functional benefits over a period of at least five years postoperatively. BioMed Central 2008-12-14 /pmc/articles/PMC2633339/ /pubmed/19077294 http://dx.doi.org/10.1186/1471-2431-8-54 Text en Copyright © 2008 Nordmark et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Nordmark, Eva
Josenby, Annika Lundkvist
Lagergren, Jan
Andersson, Gert
Strömblad, Lars-Göran
Westbom, Lena
Long-term outcomes five years after selective dorsal rhizotomy
title Long-term outcomes five years after selective dorsal rhizotomy
title_full Long-term outcomes five years after selective dorsal rhizotomy
title_fullStr Long-term outcomes five years after selective dorsal rhizotomy
title_full_unstemmed Long-term outcomes five years after selective dorsal rhizotomy
title_short Long-term outcomes five years after selective dorsal rhizotomy
title_sort long-term outcomes five years after selective dorsal rhizotomy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2633339/
https://www.ncbi.nlm.nih.gov/pubmed/19077294
http://dx.doi.org/10.1186/1471-2431-8-54
work_keys_str_mv AT nordmarkeva longtermoutcomesfiveyearsafterselectivedorsalrhizotomy
AT josenbyannikalundkvist longtermoutcomesfiveyearsafterselectivedorsalrhizotomy
AT lagergrenjan longtermoutcomesfiveyearsafterselectivedorsalrhizotomy
AT anderssongert longtermoutcomesfiveyearsafterselectivedorsalrhizotomy
AT strombladlarsgoran longtermoutcomesfiveyearsafterselectivedorsalrhizotomy
AT westbomlena longtermoutcomesfiveyearsafterselectivedorsalrhizotomy