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Ran KR, Das O, Johnston DT, Vutakuri N, Ranganathan S, Broachwala M, Chopra H, Long Azad C, Azad TD, Robinson S, Belzberg AJ, Tuffaha SH, Lubelski D. Nerve-Targeted Surgical Treatments for Spasticity: A Narrative Review. World Neurosurg 2024; 187:104-113. [PMID: 38649021 DOI: 10.1016/j.wneu.2024.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
Spasticity is a potentially debilitating symptom of various acquired and congenital neurologic pathologies that, without adequate treatment, may lead to long-term disability, compromise functional independence, and negatively impact mental health. Several conservative as well as non-nerve targeted surgical strategies have been developed for the treatment of spasticity, but these may be associated with significant drawbacks, such as adverse side effects to medication, device dependence on intrathecal baclofen pumps, and inadequate relief with tendon-based procedures. In these circumstances, patients may benefit from nerve-targeted surgical interventions such as (i) selective dorsal rhizotomy, (ii) hyperselective neurectomy, and (iii) nerve transfer. When selecting the appropriate surgical approach, preoperative patient characteristics, as well as the risks and benefits of nerve-targeted surgical intervention, must be carefully evaluated. Here, we review the current evidence on the efficacy of these nerve-targeted surgical approaches for treating spasticity across various congenital and acquired neurologic pathologies.
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Affiliation(s)
- Kathleen R Ran
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Oishika Das
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - David T Johnston
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Neha Vutakuri
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA
| | | | - Mustafa Broachwala
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Harman Chopra
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Chao Long Azad
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Allan J Belzberg
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Teles de Oliveira Filho I, Romero PC, Rezende AP, Costa BBS, Oliveira SD, Fontoura EAF, Botelho RV. Cervical dorsal rhizotomy for upper limbs spasticity. Case report. Acta Neurochir (Wien) 2024; 166:157. [PMID: 38546890 DOI: 10.1007/s00701-024-06041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
Spasticity is a prevalent symptom of upper motor neuron syndrome, becoming debilitating when hindering voluntary movement and motor function and causing contractures and pain. Functional neurosurgery plays a crucial role in treating severe spasticity. Despite extensive literature on SDR for lower limb spasticity, there is a scarcity of papers regarding the procedure in the cervical region to alleviate upper limb spasticity. This case report details a cervical dorsal rhizotomy (CDR) performed for upper limb spasticity, resulting in significant improvement in spasticity with sustained outcomes and low complication rates. Neuroablative procedures like CDR become an option to treat spasticity.
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Affiliation(s)
- Italo Teles de Oliveira Filho
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil.
- Health Sciences Post-Graduation Program, Instituto de Assistência Médica ao Servidor Público Estadual - IAMSPE, São Paulo, Brazil.
| | - Paulo Cesar Romero
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil
| | | | - Bruno Braga Sisnando Costa
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil
| | - Saul Dalla Oliveira
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil
| | | | - Ricardo Vieira Botelho
- Health Sciences Post-Graduation Program, Instituto de Assistência Médica ao Servidor Público Estadual - IAMSPE, São Paulo, Brazil
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Maki Y, Takagawa M, Goda A, Katsura J, Yanagibashi K. Successful Continuation of Oral Intake in a Dysphagic and Tetraplegic Patient With Alternate Right and Left Complete Lateral Decubitus Positions in Rehabilitation. Cureus 2023; 15:e38667. [PMID: 37292544 PMCID: PMC10246513 DOI: 10.7759/cureus.38667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/10/2023] Open
Abstract
Cervical spinal cord injury can result in dysphagia and tetraplegia. Dysphagia therapy can be required to avoid aspiration pneumonia during oral intake for persons with cervical spinal cord injury. Complete lateral decubitus position may be a specific position for safe swallowing. However, the literature on dysphagia therapy in complete lateral decubitus position for persons with tetraplegia and dysphagia is limited. We present the case of a 76-year-old man with dysphagia and tetraplegia secondary to cervical cord injury. As the patient wished for oral intake, swallowing training in an elevated position of the head at 60° was already initiated. Two days after admission, aspiration pneumonia occurred. As the spasticity increased continuously, the patient could not comfortably undertake swallowing training in an elevated head position of 60°. The flexible endoscopic evaluation of swallowing (FEES) was performed for the patient. The patient did not swallow water or jelly safely in an elevated head position. However, the patient swallowed jelly safely in the right complete lateral decubitus position. Two months after the initiation of oral intake in the right complete lateral decubitus position, the second FEES revealed that the patient swallowed jelly and food in the form of paste safely in the left complete lateral decubitus position. To relieve the pain of the right shoulder induced by continuous right complete lateral decubitus position, the patient retained oral intake in the left or right complete lateral decubitus position alternately for six months without recurrent aspiration pneumonia. Right and left complete lateral decubitus positions when alternately performed in swallowing training can be useful and safe for a patient with dysphagia and tetraplegia secondary to cervical spinal cord injury.
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Affiliation(s)
- Yoshinori Maki
- Neurosurgery, Hikone Chuo Hospital, Hikone, JPN
- Rehabilitation, Hikari Hospital, Otsu, JPN
| | | | - Akio Goda
- Physical Therapy, Kyoto Tachibana University, Kyoto, JPN
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Oraee-Yazdani S, Tavanaei R, Rezaee-Naserabad SS, Khannejad S, Alizadeh Zendehrood S, Yazdani KO, Zali A. Safety and Potential Efficacy of Selective Dorsal Rhizotomy in Adults with Spinal Cord Injury-Induced Spasticity: An Open-Label, Non-Randomized, Single-Arm Trial. World Neurosurg 2023; 170:e806-e816. [PMID: 36460198 DOI: 10.1016/j.wneu.2022.11.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Despite the abundant literature on the use of selective dorsal rhizotomy (SDR) in spastic cerebral palsy, no investigation has evaluated its use in adult patients with chronic spinal cord injury (SCI)-induced spasticity. The present investigation aimed to evaluate the safety and potential efficacy of SDR in chronic SCI-induced spasticity for the first time. METHODS In this open-label, single-arm, non-randomized clinical trial, all patients were assigned to the single study intervention arm and underwent SDR. The primary outcome measure was the safety profile of SDR. Secondary outcome measures were Modified Ashworth Scale, Penn Spasm Frequency Scale, visual analog scale for spasticity, Spinal Cord Injury Spasticity Tool, Spinal Cord Independence measure version III, and Short Form 36 Health Survey Questionnaire. RESULTS Six patients with cervical SCI and 4 with thoracic SCI were allocated to the single study intervention arm. No adverse event attributable to the SDR was found. Moreover, all secondary outcome measures of the study improved significantly over the study period (P < 0.001). Multiple regression analysis also found a significant association between level of injury and changes in average Modified Ashworth Scale scores (P = 0.041), Spinal Cord Injury Spasticity Tool score (P = 0.013), and Spinal Cord Independence measure version III total (P = 0.002) and mobility domain scores (P = 0.004) at 12-month postoperatively. CONCLUSIONS This clinical trial indicated that SDR is a safe and potentially effective procedure in patients with severe and intractable SCI-induced spasticity. However, future clinical trials with larger sample sizes and adequate power are required to validate our findings regarding efficacy.
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Affiliation(s)
- Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Roozbeh Tavanaei
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Saeed Rezaee-Naserabad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samin Khannejad
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Alizadeh Zendehrood
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Oraii Yazdani
- Department of cardiovascular diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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McIntyre A, Sadowsky C, Behrman A, Martin R, Augutis M, Cassidy C, Betz R, Ertzgaard P, Mulcahey MJ. A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:13-90. [PMID: 35521053 PMCID: PMC9009193 DOI: 10.46292/sci21-00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
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Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Parkwood Institute, London, Canada
| | - Cristina Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
,Kosair Charities Center for Pediatric Neurorecovery, Louisville, Kentucky
| | - Rebecca Martin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Caitlin Cassidy
- St. Joseph’s Health Care London, Parkwood Institute, London, Canada
| | - Randal Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
,Department of Orthopedics, Mount Sinai Hospital, New York, New York
| | - Per Ertzgaard
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Woodbury, New Jersey
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Ryan M, Flavin M, Oleszek J, Bodkin A, Wilson AM, Wilkinson C. Selective dorsal rhizotomy for spasticity associated with spinal cord injury sustained during surgery for spinal lipomatous malformation: A case report. J Pediatr Rehabil Med 2022; 15:377-381. [PMID: 35661026 DOI: 10.3233/prm-200809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Selective dorsal rhizotomy (SDR) was used to treat lower extremity spasticity in an ambulatory 7-year-old girl with a history of a T10 spinal lipoma. The spasticity was the result of an AIS D spinal cord injury (SCI) suffered during untethering surgery at age 2 years. After SDR and a course of intensive inpatient rehabilitation, the patient's gait improved markedly. To the authors' knowledge, this is the first published case of SDR as a treatment for spasticity in a patient with a spinal lipomatous malformation.
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Affiliation(s)
- Megan Ryan
- Rocky Vista University College of Osteopathic Medicine, Parker, CO, USA.,Department of Neurosurgery, University of Colorado School of Medicine and Division of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Marisa Flavin
- University of Utah Department of Physical Medicine & Rehabilitation, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Joyce Oleszek
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Amy Bodkin
- Department of Physical Medicine & Rehabilitation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Anne-Marie Wilson
- Department of Physical Therapy, Children's Hospital Colorado, Aurora, CO, USA
| | - Corbett Wilkinson
- Department of Neurosurgery, University of Colorado School of Medicine and Division of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
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Abbott R. The selective dorsal rhizotomy technique for spasticity in 2020: a review. Childs Nerv Syst 2020; 36:1895-1905. [PMID: 32642977 DOI: 10.1007/s00381-020-04765-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/23/2022]
Abstract
This review looks at the advances in the surgical technique, selective dorsal rhizotomy, used for the management of spasticity in children.
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Affiliation(s)
- Rick Abbott
- Albert Einstein College of Medicine, Montefiore Health System, 110 E. 210th St, Bronx, NY, 10467, USA.
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8
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Sun Q, Huang W, Deng B, Ren J, Zhao Y, Mu X, Xu L. The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR). BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2020.9050007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Spasticity is the main disabling clinical manifestation of children with cerebral palsy (CP). Selective dorsal rhizotomy (SDR) has been performed for the treatment of spastic CP in Asia for quite some time from 1990. The purpose of this review is to discuss the historical origin and development of SDR. Our goal here is to identify the current patient selection criteria for SDR and to point out indications and contraindications based on the patients with CP, age from 2 to 18 years-old, over 6000 cases, who received SDR surgery with spasticity of muscle tension more than 3 degrees in our center. We also discuss evidence-based approaches on how to evaluate postoperative patient outcomes of SDR and how complications can be avoided. Finally, we mention progress made in terms of SDR technical advances and how improvements can be made in the future. In conclusion, SDR surgery is a reliable way to improve outcomes of patients with spastic CP and can be done carefully in patients as long as stringent selection criteria are used. However, more research and technological advancements are needed to help address associated complications.
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Affiliation(s)
- Qi Sun
- Department of Orthopedics, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
| | - Wenling Huang
- Department of Gynaecology, Dongfang Hospital, Beijing University of
Chinese Medicine, Beijing 100078, China
| | - Bowen Deng
- Department of Orthopedics, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
| | - Jingpei Ren
- Department of Orthopedics, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
| | - Yi Zhao
- Department of Orthopedics, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
| | - Xiaohong Mu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
| | - Lin Xu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University
of Chinese Medicine, Beijing 100700, China
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9
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Hon AJ, Kraus P. Spasticity Management After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00280-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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The role of selective dorsal rhizotomy in the management of post-traumatic spasticity: systematic review. Neurosurg Rev 2020; 44:213-221. [PMID: 32020384 DOI: 10.1007/s10143-020-01255-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 01/04/2020] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
There is a huge burden of patients suffering from trauma-induced disabling spasticity the world over. There are surprisingly few modalities of treatment with a sustained, proven benefit which can be offered to such patients. Selective dorsal rhizotomy (SDR) has been used with proven success in treating spasticity in patients of cerebral palsy, both in children and in adults. The rationale behind using the procedure in post-traumatic cases is reviewed, along with the cases reported till date in the world literature. The indications, surgical procedure used, outcome and complications, if any, are described. Most of the cases described in the literature have shown a favourable outcome with minimal complications. SDR can become an important tool in the armamentarium of the clinician treating this condition.
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Jeffery SMT, Markia B, Pople IK, Aquilina K, Smith J, Mohamed AZ, Burchell A, Jenkins L, Walsh P, Clark N, Sacree J, Cramp M, Babiker MOE, Atherton WG, Clarke A, Edwards RJ. Surgical Outcomes of Single-Level Bilateral Selective Dorsal Rhizotomy for Spastic Diplegia in 150 Consecutive Patients. World Neurosurg 2019; 125:e60-e66. [PMID: 30659965 DOI: 10.1016/j.wneu.2018.12.187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Selective dorsal rhizotomy (SDR) is used to improve spasticity, gait, and pain in children with spastic diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence, and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single United Kingdom center. METHODS Demographics, surgical, postoperative, and follow-up data for all patients undergoing SDR between 2011 and 2016 were collected from medical records. RESULTS Preoperative Gross Motor Function Classification System levels in 150 consecutive patients were II (35%), III (65%), and IV (1%). Median age was 6 years and 58% were male patients. There were no deaths, cerebrospinal fluid leaks, returns to theater, or readmissions within 30 days. There were no new motor or sphincter deficits. Postoperative neuropathic pain was reported by 5.3% and sensory symptoms by 8.7%. Other complications included: postoperative nausea and vomiting (19.3%), superficial wound infection (3.3%), urinary retention (1.3%), headache (6.7%), and urine or chest infection (4.7%). Follow-up data were available for all patients (93% to 12 months, 72% to 24 months). Persistent neuropathic symptoms were reported in 6.5% at 24 months. CONCLUSIONS SDR using a single-level approach is a safe procedure with low surgical morbidity. This study complements the growing evidence base in support of SDR for spastic diplegia and should help inform decisions when considering treatment options.
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Affiliation(s)
- Samuel M T Jeffery
- Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom; South West Neurosurgery Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom
| | - Balázs Markia
- Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; National Institute for Clinical Neurosciences, Budapest, Hungary
| | - Ian K Pople
- Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Kristian Aquilina
- Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom; Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jenny Smith
- Department of Paediatric Physiotherapy, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Amr Z Mohamed
- Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Alison Burchell
- Department of Paediatric Physiotherapy, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Lyn Jenkins
- Department of Paediatric Physiotherapy, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Peter Walsh
- Department of Neurophysiology, North Bristol NHS Trust, Bristol, United Kingdom
| | - Natasha Clark
- Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Jenny Sacree
- Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Mary Cramp
- Centre for Health and Clinical Research, University of the West of England, Bristol, United Kingdom
| | - Mohamed O E Babiker
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - William Guy Atherton
- Department of Orthopaedic Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Anna Clarke
- Department of Orthopaedic Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Richard J Edwards
- Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
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13
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Gras M, Leclercq C. Spasticity and hyperselective neurectomy in the upper limb. HAND SURGERY & REHABILITATION 2017; 36:391-401. [DOI: 10.1016/j.hansur.2017.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/15/2017] [Accepted: 06/13/2017] [Indexed: 10/18/2022]
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Chang MC, Cho YW. Effects of pulsed radiofrequency on spasticity in patients with spinal cord injury: a report of two cases. Neural Regen Res 2017; 12:977-980. [PMID: 28761432 PMCID: PMC5514874 DOI: 10.4103/1673-5374.208593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spasticity following spinal cord injury (SCI) results in functional deterioration and reduced quality of life. Herein, we report two SCI patients who presented with good response to pulsed radiofrequency (PRF) for the management of spasticity in the lower extremities. Patient 1 (a 47-year-old man) had complete thoracic cord injury and showed a phasic spasticity on the extensor of both knees (3-4 beats clonus per every 30 seconds) and tonic spasticity (Modified Ashworth Scale: 3) on both hip adductors. Patient 2 (a 64-year-old man) had incomplete cervical cord injury and showed a right ankle clonus (approximately 20 beats) when he walked. After the application of PRF to both L2 and L3 dorsal root ganglion (DRG) (patient 1) and right S1 DRG (patient 2) with 5 Hz and 5 ms pulsed width for 360 seconds at 45V under the C-arm guide, all spasticity disappeared or was reduced. Moreover, the effects of PRF were sustained for approximately 6 months with no side effects. We believe that PRF treatment can be useful for patients with spasticity after SCI.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, Republic of Korea
| | - Yun Woo Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, Republic of Korea
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15
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Sharma J, Bonfield C, Steinbok P. Selective dorsal rhizotomy for hereditary spastic paraparesis in children. Childs Nerv Syst 2016; 32:1489-94. [PMID: 27312078 DOI: 10.1007/s00381-016-3122-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine the outcomes for children who underwent selective dorsal rhizotomy (SDR) for the treatment of spasticity related to spinal pathology. METHODS We performed a retrospective review of all cases of SDR at our institution over the last 30 years and identified patients in whom spasticity was attributed to spinal rather than cerebral pathology. We gathered demographic information and recorded functional status and spasticity scores pre-operatively and over long-term follow-up. RESULTS We identified four patients who underwent SDR for spinal-related spasticity. All four had hereditary spastic paraparesis (HSP). All patients had reduced spasticity in the lower limbs after SDR, which was maintained over long-term follow-up. Two patients had a more severe and progressive subtype of HSP, and both these patients exhibited functional decline despite improvement in tone. CONCLUSIONS Our findings suggest SDR is a reasonable option to consider for relief of spinal-related spasticity in uncomplicated hereditary spastic paraparesis. However, SDR for the treatment of complicated HSP seems to carry more risks and have a less predictable outcome. Overall, SDR is probably best reserved for pathologies that are relatively stable in their disease course.
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Affiliation(s)
- Julia Sharma
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Paul Steinbok
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada. .,Division of Pediatric Neurosurgery, British Columbia Children's Hospital (BCC), 4480 Oak Street, Rm K3-216, Vancouver, BC, V6H 3V4, Canada.
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Barakat MI, Elhady W, Gouda M, Taha M, Metwaly I. Surgical management of intractable spasticity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:928-35. [PMID: 26667812 DOI: 10.1007/s00586-015-4326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spasticity is motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex, as one component of the upper motor neuron syndrome. PURPOSE This study aimed at comparing between spinally based (dorsal rhizotomy) versus peripherally based (selective neurotomy) surgical procedures in management of hypertonia in the lower limbs of pediatrics. METHODS Over a 3-year period, 50 children with intractable, lower limb spasticity were prospectively treated by selective neurotomy (group A, 35 patients) and dorsal rhizotomy (group B, 15 patients) with 6 months' follow-up period. RESULTS The operative duration was longer with dorsal rhizotomy with mean of 292.2 min versus 76.8 min with neurotomy (P = 0.001) and the hospital stay of dorsal rhizotomy was longer with mean of 6.2 days versus 1.7 days with neurotomy (P = 0.001). Muscles power exhibited significant improvement in 53.3% of the total rhizotomies (P = 0.001). Following neurotomies; muscle tone showed marked improvement in 69.3% muscles which had normal tone and 31.9% of muscles had mild spasticity (P = 0.001). The H/M ratio following dorsal rhizotomies showed marked reduction of the ratio, and the mean was 0.11 versus 0.58 preoperatively. CONCLUSION Both neurotomies and dorsal rhizotomies were safe surgical procedures and were provided with good improvement in respect of: muscle power, severity of spasticity, patient's ambulation, gait, range of joint movement, associated pain, functional disability, and nerve excitability with no significant difference between both procedures.
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Affiliation(s)
- Mohamed I Barakat
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Waleed Elhady
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed Gouda
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mahmoud Taha
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Ibrahim Metwaly
- Neurosurgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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