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Fong MM, Gibson N, Williams SA, Jensen L. Clinical functional outcome measures for children with cerebral palsy after gait corrective orthopaedic surgery: A scoping review. Dev Med Child Neurol 2023; 65:1573-1586. [PMID: 37147852 DOI: 10.1111/dmcn.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/07/2023]
Abstract
AIM To identify the most frequently reported non-instrumented measures of gait, activity, and participation in children with cerebral palsy (CP) after undergoing gait corrective orthopaedic surgery. METHOD Four databases were searched from database inception to the 9th December 2021 for studies that evaluated functional outcomes for children with CP under 18 years undergoing gait corrective orthopaedic surgery. RESULTS Of 547 citations, 44 publications (n = 3535 participants, n = 1789 males, mean age 10 years 5 months [SD = 3 years 3 months], Gross Motor Function Classification System levels I-III at the time of surgery) were eligible for inclusion. Fourteen different outcome measures were used: one measure of gait, 10 measures of activity, and three measures of participation. Gait was measured with the Edinburgh Visual Gait Scale (EVGS; 4 out of 44). The most common activity and participation measures were the Functional Mobility Scale (FMS; 15 out of 44) and Pediatric Outcomes Data Collection Instrument (11 out of 44) respectively. No studies reported a combination of gait, activity, and participation measures. INTERPRETATION The EVGS and FMS should be considered as core outcome measures in gait corrective orthopaedic surgery, while a measure of participation is unclear. Additional considerations for developing a comprehensive suite of outcomes include identifying a combination of clinical measures and performance-reflective questionnaires that are standardized for children with CP undergoing surgery and meaningful to clinicians and families.
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Affiliation(s)
- Maxine M Fong
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Noula Gibson
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Kids Rehab WA, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sian A Williams
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lynn Jensen
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
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McMulkin ML, MacWilliams BA, Nelson EA, Munger ME, Chen BPJ, Novacheck TF, Carroll KL, Stotts AK, Carter LH, Mader SL, Hayes B, Baird GO, Schwartz MH. The long-term effects of aggressive spasticity reducing treatment, including selective dorsal rhizotomy, on joint kinematic outcomes of persons with cerebral palsy. Gait Posture 2023; 105:139-148. [PMID: 37572544 DOI: 10.1016/j.gaitpost.2023.07.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) creates a large and permanent reduction of spasticity for children with cerebral palsy (CP). Previous SDR outcomes studies have generally lacked appropriate control groups, had limited sample sizes, or reported short-term follow-up, limiting evidence for improvement in long-term gait function. RESEARCH QUESTION Does aggressive spasticity management for individuals with CP improve long-term gait kinematics (discrete joint kinematics) compared to a control group of individuals with CP with minimal spasticity management? METHODS This study was a secondary analysis - focused on joint-level kinematics - of a previous study evaluating the long-term outcomes of SDR. Two groups of participants were recruited based on a retrospectively completed baseline clinical gait study. One group received aggressive spasticity treatment including a selective dorsal rhizotomy (Yes-SDR group), while the other group had minimal spasticity management (No-SDR group). Both groups had orthopedic surgery treatment. Groups were matched on baseline spasticity. All participants prospectively returned for a follow-up gait study in young adulthood (greater than 21 years of age and at least 10 years after baseline). Change scores in discrete kinematic variables from baseline to follow-up were assessed using a linear model that included treatment arm (Yes-SDR, No-SDR), baseline age, and baseline kinematic value. For treatment arm, 5° and 5 Gait Deviation Index points were selected as thresholds to be considered a meaningful difference between treatment groups. RESULTS At follow-up, there were no meaningful differences in pelvis, hip, knee, or ankle kinematic variable changes between treatment arms. Max knee flexion - swing showed a moderate treatment effect for Yes-SDR, although it did not reach the defined threshold. SIGNIFICANCE Aggressive spasticity treatment does not result in meaningful differences in gait kinematics for persons with cerebral palsy in young adulthood compared to minimal spasticity management with both groups having orthopedic surgery.
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Affiliation(s)
- Mark L McMulkin
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA.
| | - Bruce A MacWilliams
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA; University of Utah, Department of Orthopedic Surgery, USA
| | | | | | - Brian Po-Jung Chen
- Gillette Children's, USA; Motion Analysis Laboratory, Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital - Linkou Branch, Taoyuan City, Taiwan; Department of Pediatric Orthopedics, Chang Gung Memorial Hospital - Linkou Branch, Taoyuan City, Taiwan
| | - Tom F Novacheck
- Gillette Children's, USA; University of Minnesota, Department of Orthopedic Surgery, USA
| | - Kristen L Carroll
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA; University of Utah, Department of Orthopedic Surgery, USA
| | - Alan K Stotts
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA; University of Utah, Department of Orthopedic Surgery, USA
| | - Lisa H Carter
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA
| | - Shelley L Mader
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA
| | - Brianna Hayes
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA
| | - Glen O Baird
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA
| | - Michael H Schwartz
- Gillette Children's, USA; University of Minnesota, Department of Orthopedic Surgery, USA
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MacWilliams BA, McMulkin ML, Duffy EA, Munger ME, Chen BPJ, Novacheck TF, Schwartz MH. Long-term effects of spasticity treatment, including selective dorsal rhizotomy, for individuals with cerebral palsy. Dev Med Child Neurol 2022; 64:561-568. [PMID: 34755903 DOI: 10.1111/dmcn.15075] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 01/07/2023]
Abstract
AIM To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy. METHOD This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline. Children at one center underwent spasticity treatment including SDR (Yes-SDR, n=35) and antispastic injections. Children at two other centers had no SDR (No-SDR, n=40 total) and limited antispastic injections. All underwent subsequent orthopedic treatment. Participants returned for comprehensive long-term assessment (age ≥21y, follow-up ≥10y). Assessment included spasticity, contracture, bony alignment, strength, gait, walking energy, function, pain, stiffness, participation, and quality of life. RESULTS Spasticity was effectively reduced at long-term assessment in the Yes-SDR group and was unchanged in the No-SDR group. There were no meaningful differences between the groups in any measure except the Gait Deviation Index (Yes-SDR + 11 vs No-SDR + 5) and walking speed (Yes-SDR unchanged, No-SDR declined 25%). The Yes-SDR group underwent more subsequent orthopedic surgery (11.9 vs 9.7 per individual) and antispastic injections to the lower limbs (14.4 vs <3, by design). INTERPRETATION Untreated spasticity does not cause meaningful impairments in young adulthood at the level of pathophysiology, function, or quality of life.
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Affiliation(s)
- Bruce A MacWilliams
- Shriners Hospitals for Children, Salt Lake City, UT, USA.,Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Brian Po-Jung Chen
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Department of Pediatric Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tom F Novacheck
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Department of Orthopedic Surgery, University of Minnesota, St. Paul, MN, USA
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Department of Orthopedic Surgery, University of Minnesota, St. Paul, MN, USA
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Chang Y, Lin S, Li Y, Liu S, Ma T, Wei W. Umbilical cord blood CD34 + cells administration improved neurobehavioral status and alleviated brain injury in a mouse model of cerebral palsy. Childs Nerv Syst 2021; 37:2197-2205. [PMID: 33559728 PMCID: PMC8263416 DOI: 10.1007/s00381-021-05068-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Cerebral palsy (CP) is the most common neuromuscular disease in children, and currently, there is no cure. Several studies have reported the benefits of umbilical cord blood (UCB) cell treatment for CP. However, these studies either examined the effects of UCB cell fraction with a short experimental period or used neonatal rat models for a long-term study which displayed an insufficient immunological reaction and clearance of human stem cells. Here, we developed a CP model by hypoxia-ischemic injury (HI) using immunodeficient mice and examined the effects of human UCB CD34+ hematopoietic stem cells (HSCs) on CP therapy over a period of 8 weeks. METHODS Sixty postnatal day-9 (P9) mouse pups were randomly divided into 4 groups (n = 15/group) as follows: (1) sham operation (control group), (2) HI-induced CP model, (3) CP model with CD34+ HSC transplantation, and (4) CP model with CD34- cell transplantation. Eight weeks after insult, the sensorimotor performance was analyzed by rotarod treadmill, gait dynamic, and open field assays. The pathological changes in brain tissue of mice were determined by HE staining, Nissl staining, and MBP immunohistochemistry of the hippocampus in the mice. RESULTS HI brain injury in mice pups resulted in significant behavioral deficits and loss of neurons. Both CD34+ HSCs and CD34- cells improved the neurobehavioral statuses and alleviated the pathological brain injury. In comparison with CD34- cells, the CD34+ HSC compartments were more effective. CONCLUSION These findings indicate that CD34+ HSC transplantation was neuroprotective in neonatal mice and could be an effective therapy for CP.
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Affiliation(s)
- Yanqun Chang
- Department of Medical Rehabilitation, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shouheng Lin
- Key Laboratory of Regenerative Biology, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yongsheng Li
- Guangdong Cord Blood Bank, Guangzhou, China. .,Guangzhou Municipality Tianhe Nuoya Bio-engineering Co., Ltd., Guangzhou, China.
| | - Song Liu
- Guangzhou Reborn Health Management Consultation Co., Ltd., Guangzhou, China
| | - Tianbao Ma
- Guangdong Cord Blood Bank, Guangzhou, China ,Guangzhou Municipality Tianhe Nuoya Bio-engineering Co., Ltd., Guangzhou, China
| | - Wei Wei
- Guangdong Cord Blood Bank, Guangzhou, China ,Guangzhou Municipality Tianhe Nuoya Bio-engineering Co., Ltd., Guangzhou, China
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He X, Xu Y, Yang X. [Precise diagnosis and treatment of spastic cerebral palsy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1584-1588. [PMID: 31823563 DOI: 10.7507/1002-1892.201903072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the advancement of precise diagnosis and treatment for spastic cerebral palsy in recent years. Methods The literature and own experiences were reviewed, and the surgical method, precise diagnosis, and personalized treatment of spastic cerebral palsy based on the classification of spastic cerebral palsy were summarized and analyzed. Results The common classification of spastic cerebral palsy are gross motor function classification system (GMFCS) and manual ability classification system (MACS). The surgical methods of spastic cerebral palsy can be divided into soft tissue surgery, nerve surgery, and bone and joint surgery. The precise diagnosis of spastic cerebral palsy includes qualitative diagnosis, localization diagnosis, and quantitative diagnosis. Based on precise diagnosis and classification, one or more corresponding surgical methods are selected for treatment. Conclusion The manifestations of spastic cerebral palsy are so diverse that it is necessary to select rational surgeries based on precise diagnosis to achieve individualized treatment.
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Affiliation(s)
- Xiaoqing He
- Institute of Trauma Orthopedic Surgery, the 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Yongqing Xu
- Institute of Trauma Orthopedic Surgery, the 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032,
| | - Xi Yang
- Institute of Trauma Orthopedic Surgery, the 920 Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
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Chagas PS, Peixoto JG, Ortis MDDC, Ribeiro LC, Alves JWF, Defilipo EC. Comprimento de isquiotibiais, função motora grossa e marcha em crianças e adolescentes com paralisia cerebral. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18018026042019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo desse estudo é verificar se há relação entre o comprimento dos isquiotibiais, função motora grossa e marcha em crianças e adolescentes com paralisia cerebral (PC). Os participantes, entre 6 e 18 anos, foram classificados pelo Sistema de Classificação da Função Motora Grossa (GMFCS) nos níveis I, II e III através da escala Tardieu modificada, para avaliar o comprimento dos músculos isquiotibiais, sendo identificados em: R1 (primeira resistência da extensão da perna), R2 (segunda resistência da extensão da perna) e R2-R1 (diferença entre R1 e R2) do membro inferior esquerdo e direito. Para avaliar a função motora grossa, foi utilizado o teste gross motor function measure (GMFM-88), e a escala physicians rating scale modificada (PRS) foi utilizada para avaliar a marcha. Vinte e três participantes foram incluídos e os resultados evidenciaram correlações moderadas entre R1, R2 e PRS do membro inferior esquerdo e GMFM. As demais variáveis apresentaram uma correlação fraca.
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Amirmudin NA, Lavelle G, Theologis T, Thompson N, Ryan JM. Multilevel Surgery for Children With Cerebral Palsy: A Meta-analysis. Pediatrics 2019; 143:peds.2018-3390. [PMID: 30918016 DOI: 10.1542/peds.2018-3390] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Multilevel surgery (MLS) is standard care for reducing musculoskeletal disorders among children with spastic cerebral palsy (CP). OBJECTIVE To summarize the literature examining effects of MLS and satisfaction with MLS for children with CP. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched. STUDY SELECTION Studies in which authors reported effects of or satisfaction with MLS in children with CP were selected. DATA EXTRACTION Two authors screened and extracted data on gross motor function, gait speed, gait (eg, Gait Profile Score), range of motion, strength, spasticity, participation, quality of life, satisfaction, and adverse events. RESULTS Seventy-four studies (3551 participants) were identified. One was a randomized controlled trial (RCT) (n = 19); the remainder were cohort studies. Pooled analysis of cohort studies revealed that MLS did not have a long-term effect on gross motor function (standardized mean difference [SMD]: 0.38; 95% confidence interval [CI]: -0.25 to 1.01) or gait speed (SMD: 0.12; 95% CI: -0.01 to 0.25) but did improve gait (SMD: -0.80; 95% CI: -0.95 to -0.65). The RCT also revealed no effect of MLS on gross motor function but improvements in the Gait Profile Score at 1 year. Participation and quality of life were reported in only 5 studies, and adverse events were adequately reported in 17 studies. LIMITATIONS Data were largely from cohort studies. CONCLUSIONS Findings reveal that gait, but not gross motor function, improves after MLS. RCTs and improved reporting of studies of MLS are required.
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Affiliation(s)
- Noor Amirah Amirmudin
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grace Lavelle
- Department of Clinical Sciences, Brunel University London, London, United Kingdom; and
| | - Tim Theologis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Nicky Thompson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Jennifer M Ryan
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; .,Department of Clinical Sciences, Brunel University London, London, United Kingdom; and
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Schwarze M, Block J, Kunz T, Alimusaj M, Heitzmann DWW, Putz C, Dreher T, Wolf SI. The added value of orthotic management in the context of multi-level surgery in children with cerebral palsy. Gait Posture 2019; 68:525-530. [PMID: 30623847 DOI: 10.1016/j.gaitpost.2019.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/28/2018] [Accepted: 01/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment of cerebral palsy includes an interdisciplinary concept and in more severe cases the well-established multi-level surgery (MLS). Different kinds of orthoses are typically part of postoperative treatment but there is a lack of knowledge about their additional benefit. RESEARCH QUESTION Do ankle foot orthoses lead to an additional, measurable improvement of gait after MLS? METHODS 20 children with bilateral spastic cerebral palsy (9 retrospective, 11 in a postoperative clinical routine) were included. All had a preoperative gait analysis before MLS. Postoperatively, they were fitted with different ankle foot orthoses (AFO), depending on their individual needs. Dynamic ankle foot orthoses (DAFO), combined DAFO with additional dynamic, elastic shank adaptation (DESA) and ground reaction force AFOs (GRAFO) were used. Patients underwent a second gait analysis 1.5 (± 0.6) years postoperatively barefoot and with orthoses. Data analysis included testing for normal distribution (Shapiro-Wilk-Test) and further nonparametric statistical testing on basis of a Wilcoxon Single-Rank Test. RESULTS The operation produced changes in the hip, knee and ankle joint, and the pelvis. Spatiotemporal parameters showed significant changes due to additional use of the orthoses. Further, additional kinematic changes occurred at the hip, knee and ankle joint as well as the foot. The Gillette Gait Index (GGI) improved significantly by supplementary orthoses, but not by surgery alone. The Gait Profile Score (GPS) and Gait Deviation Index (GDI) rather showed changes due to the surgery. SIGNIFICANCE MLS significantly improves GPS and GDI more than a year after surgery, which can be interpreted as an improvement in gait pattern. In contrast, the GGI is improved by additional postoperative orthotic treatment, which implies that walking ability itself has improved, rather than the gait pattern. Orthoses show a positive additional effect on surgical results at different anatomical levels. Spatiotemporal parameters are positively influenced solely by additional orthotic support.
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Affiliation(s)
- M Schwarze
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany.
| | - J Block
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany
| | - T Kunz
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany
| | - M Alimusaj
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany
| | - D W W Heitzmann
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany
| | - C Putz
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany
| | - T Dreher
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany; Pediatric Orthopaedics and Traumatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - S I Wolf
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr. 200, 69118, Heidelberg, Germany
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Abstract
Traumatic brain injury (TBI) is an alteration in brain function, caused by an external force, which may be a hit on the skull, rapid acceleration or deceleration, penetration of an object, or shock waves from an explosion. Traumatic brain injury is a major cause of morbidity and mortality worldwide, with a high prevalence rate in pediatric patients, in which treatment options are still limited, not available at present neuroprotective drugs. Although the therapeutic management of these patients is varied and dependent on the severity of the injury, general techniques of drug types are handled, as well as physical and surgical. Baclofen is a muscle relaxant used to treat spasticity and improve mobility in patients with spinal cord injuries, relieving pain and muscle stiffness. Pharmacological support with baclofen is contradictory, because disruption of its oral administration may cause increased muscle tone syndrome and muscle spasm, prolonged seizures, hyperthermia, dysesthesia, hallucinations, or even multisystem organ failure. Combined treatments must consider the pathophysiology of broader alterations than only excitation/inhibition context, allowing the patient's reintegration with the greatest functionality.
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Funk JF, Haberl H. Monosegmental laminoplasty for selective dorsal rhizotomy--operative technique and influence on the development of scoliosis in ambulatory children with cerebral palsy. Childs Nerv Syst 2016; 32:819-25. [PMID: 26759019 DOI: 10.1007/s00381-016-3016-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy (CP) and is performed either through a lumbosacral multilevel laminectomy or a single-level laminectomy at the medullary conus. Spinal interventions generally involve the risk of subsequent instability depending on the extent of structural weakening. Destabilizing spasticity in CP might further increase this risk for both options. Laminoplasty is frequently applied to reduce instability through anatomical restoration, although the unavoidable interruption of interspinous ligaments might be a reason for inconsistent results. We report on a novel technique of laminoplasty, achieving complete restoration of the dorsal column. METHODS One hundred sixteen ambulatory children with gross motor function classification scale (GMFCS) level I to III were submitted to SDR through a single-level approach. The lamina was reinserted with a previously unreported technique of laminoplasty. Osseous reintegration of the excised lamina was supposed, if its spinous process was located in place on late follow-up radiographs. Scoliosis was described via Cobb's angle. RESULTS At a mean follow-up of 33 months, radiographs were available from 72 children with a mean age at surgery of 7.2 years. Sixty-two out of the 72 reinserted laminae were supposed to be vital and reintegrated. Seven children developed a predominantly mild scoliosis. No association was found between development of scoliosis and GMFCS level or age. CONCLUSIONS This novel laminoplasty technique provides the least invasive approach for SDR. The incidence of scoliosis after this single-level approach is comparable to the natural history of ambulatory CP children.
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Affiliation(s)
- Julia Franziska Funk
- Department of Pediatric Orthopedic Surgery and Neuroorthopedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Hannes Haberl
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University of Ulm, Eythstrasse 24, 89075, Ulm, Germany
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