1
|
Blatt K, Lewis J, Bican R, Leonard J. Selective Dorsal Rhizotomy: Patient Demographics and Postoperative Physical Therapy. Pediatr Neurol 2023; 147:56-62. [PMID: 37556940 DOI: 10.1016/j.pediatrneurol.2023.07.006] [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: 09/28/2022] [Revised: 05/18/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) is a surgical procedure that permanently alters lower extremity spasticity, common in children with spastic cerebral palsy (CP). Intensive postoperative physical therapy (PT) is recommended following SDR. The first purpose of this study is to describe and compare patient demographics between children who received SDR and the population of children with CP at one institution. The second purpose of this study is to compare the completed dose of postoperative PT with the clinically recommended dose for a subset of ambulatory children who underwent SDR. METHODS This retrospective, observational study included 60 children with spastic CP following SDR. A subset (n = 12 ambulatory children) was included to describe the dose of postoperative PT. Information gathered from electronic medical records included age at the time of SDR, sex, Gross Motor Function Classification System level, anatomic distribution, race, county-level habitancy, health insurance provider, timed current procedural terminology codes, and location for postoperative PT encounters within a single institution. RESULTS Black or African American children (P = 0.002), children living in large central metro areas (P = 0.033), and children with public insurance (P ≤ 0.001) were significantly less likely to receive SDR. Children undergoing SDR do not achieve the recommended dose of PT after hospital discharge. CONCLUSION SDR is not equally accessed by patient populations, and postoperative PT frequency is below current recommendations throughout the rehabilitation process. Future studies need to investigate why these disparities exist and what prevents children from meeting the clinically recommended dose of postoperative PT after SDR.
Collapse
Affiliation(s)
- Kristen Blatt
- Division of Clinical Therapies, Department of Physical Therapy, Nationwide Children's Hospital, Columbus, Ohio.
| | - Jessica Lewis
- Division of Clinical Therapies, Department of Physical Therapy, Nationwide Children's Hospital, Columbus, Ohio
| | - Rachel Bican
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, Ohio University, Athens, Ohio
| | - Jeffrey Leonard
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
2
|
Pediatric Neuroanesthesia — a Review of the Recent Literature. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Purpose of Review
Pediatric neuroanesthesia is a growing and still challenging subspecialty. The purpose of this review is to summarize the available knowledge and highlight the most recent findings of the literature on non-traumatic pediatric neuroanesthesia care.
Recent Findings
Several human studies have confirmed the negative effects of early life anesthetic exposure. According to non-human studies, volatile anesthetics and opioids contribute to tumor progression. Tranexamic acid effectively reduces perioperative blood loss; it is used in several different doses without standard guidelines on optimal dosing. The widespread use of neuromonitoring has necessitated the development of anesthetic methods that do not affect neuromuscular transmission.
Summary
Pediatric anesthetic neurotoxicity, management of intraoperative bleeding, and the effect of anesthesia on tumor growth are among the most debated and researched topics in pediatric neuroanesthesia. The lack of evidence and clinical guidelines underlines the need for further large prospective studies in this subspecialty.
Collapse
|
3
|
Wardhani RK, Wahyuni LK, Laksmitasari B, Lakmudin A. Effect of session frequency of radial extracorporeal shockwave therapy on gastrocnemius muscle spasticity in children with spastic cerebral palsy: a double-blinded, randomised clinical trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Extracorporeal shockwave therapy has been effective in reducing spasticity in patients with spastic cerebral palsy, but there has yet to be a recommended guideline for the treatment of spasticity in children using extracorporeal shockwave therapy. The aim of this study was to evaluate the effect of session frequency of radial extracorporeal shockwave therapy on gastrocnemius muscle spasticity in children with spastic cerebral palsy. Methods This was a double-blinded, randomised controlled trial consisting of 14 patients with spastic cerebral palsy (8 boys and 6 girls), aged 5 to 12 years, who were divided into two groups. Group 1 received five true radial extracorporeal shockwave therapy sessions. Group 2 received three true radial extracorporeal shockwave therapy sessions and two sham extracorporeal shockwave therapy sessions. The Australian Spasticity Assessment Scale was measured at nine time points: 1) pre-extracorporeal shockwave therapy, 2–6) immediately after each radial extracorporeal shockwave therapy session, 7) 4 weeks after the fifth radial extracorporeal shockwave therapy session, 8) 8 weeks after the fifth radial extracorporeal shockwave therapy session, and 9) 12 weeks after the fifth radial extracorporeal shockwave therapy session. Results Both groups had a significant reduction in degree of resistance to passive movements of ankle plantar-flexor muscles measured using the Australian Spasticity Assessment Scale at all time points, relative to baseline. The mean ankle Australian Spasticity Assessment Scale in the two groups were not significantly different after the fifth extracorporeal shockwave therapy treatment (group 1: 1.13 ± 0.62; group 2: 1.50 ± 0.90, P=0.28), 4 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.12 ± 0.66; Group 2: 1.50 ± 0.90, P=0.40), 8 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.25 ± 0.68; group 2: 1.50 ± 0.90, P=0.54) and 12 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.19 ± 0.75; Group 2: 1.58 ± 0.90, P=0.28). Conclusions: The effect of radial extracorporeal shockwave therapy on spastic gastrocnemius in children with spastic cerebral palsy is not dependent on session frequency. There has yet to be a recommended guideline and research showing the factors that affect the efficacy of radial extracorporeal shockwave therapy on spastic gastrocnemius muscles in children with spastic cerebral palsy.
Collapse
Affiliation(s)
- Rizky Kusuma Wardhani
- Physical Medicine and Rehabilitation Department, University of Indonesia, Jakarta, Indonesia
| | - Luh Karunia Wahyuni
- Physical Medicine and Rehabilitation Department, University of Indonesia, Jakarta, Indonesia
| | - Budiati Laksmitasari
- Physical Medicine and Rehabilitation Department, University of Indonesia, Jakarta, Indonesia
| | - Alvin Lakmudin
- Physical Medicine and Rehabilitation Department, University of Indonesia, Jakarta, Indonesia
| |
Collapse
|
4
|
Wardhani RK, Wahyuni LK, Laksmitasari B, Lakmudin A. Effect of total number of pulses of radial extracorporeal shock wave therapy (rESWT) on hamstring muscle spasticity in children with spastic type cerebral palsy: A randomized clinical trial. J Pediatr Rehabil Med 2022; 15:159-164. [PMID: 35275569 DOI: 10.3233/prm-200796] [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
PURPOSE To evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) according to total number of pulses on hamstring muscle spasticity in children with spastic type cerebral palsy (CP). METHODS This study is a randomized controlled trial consisting of thirteen patients with spastic CP, 9 males and 4 females, aged 5 to 14 years (mean age 9.2). Twenty-five spastic hamstring muscles were divided in four groups. Group I: 500 pulses, Group II: 1,000 pulses, Group III: 1,500 pulses, and Group IV: 2,000 pulses. Australian Spasticity Assessment Scale (ASAS) was measured at four different time points (pre-ESWT, post-ESWT, 2 weeks post-ESWT, and 4 weeks post-ESWT). RESULTS All four groups showed improvement in ASAS relative to pre-treatment, although only significant in Group III (1,500 pulses). There were no statistically significant differences in ASAS between all four groups in pre-ESWT [|2(2) = 3.907, p = 0.272], immediately post-ESWT [|2(2) = 1.250, p = 0.741], 2 weeks post-ESWT vs pre-ESWT [|2(2) = 3.367, p = 0.338], and 4 weeks post-ESWT vs pre-ESWT [|2(2) = 1.566, p = 0.667]. CONCLUSION The effect of rESWT on spastic hamstring in children with spastic CP is not dependent on the number of pulses.
Collapse
Affiliation(s)
- Rizky Kusuma Wardhani
- Department of Physical Medicine and Rehabilitation, University of Indonesia, Jakarta, Indonesia
| | - Luh Karunia Wahyuni
- Department of Physical Medicine and Rehabilitation, University of Indonesia, Jakarta, Indonesia
| | - Budiati Laksmitasari
- Department of Physical Medicine and Rehabilitation, University of Indonesia, Jakarta, Indonesia
| | - Alvin Lakmudin
- Department of Physical Medicine and Rehabilitation, University of Indonesia, Jakarta, Indonesia
| |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
- Rick Abbott
- Albert Einstein College of Medicine, Montefiore Health System, 110 E. 210th St, Bronx, NY, 10467, USA.
| |
Collapse
|
6
|
Zhan Q, Yu X, Jiang W, Shen M, Jiang S, Mei R, Wang J, Xiao B. Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy? Childs Nerv Syst 2020; 36:1935-1943. [PMID: 31502037 PMCID: PMC7434794 DOI: 10.1007/s00381-019-04368-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/02/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Our aim was to test whether the newly modified rhizotomy protocol which could be effectively used to guide single-level approach selective dorsal rhizotomy (SL-SDR) to treat spastic hemiplegic cases by mainly releasing those spastic muscles (target muscles) marked pre-operatively in their lower limbs was still applicable in spastic quadriplegic or diplegic cerebral palsy (CP) cases in pediatric population. METHODS In the current study, we retrospectively conducted a cohort review of cases younger than 14 years of age diagnosed with spastic quadriplegic or diplegic CP who undergone our modified protocol-guided SL-SDR in the Department of Neurosurgery, Children's Hospital of Shanghai since July 2016 to November 2017 with at least 12 months post-op intensive rehabilitation program (pre-op GMFCS level-based). Clinical data including demographics, intra-operative EMG responses interpretation, and relevant assessment of included cases were taken from the database. Inclusion and exclusion criteria were set for the selection of patients in the current study. Muscle tone (modified Ashworth scale) and strength of those spastic muscles (muscle strength grading scale), range of motion (ROM) of those joints involved, the level of Gross Motor Function Classification System (GMFCS), and Gross Motor Function Measure 66 items (GMFM-66) score of those cases were our focus. RESULTS A total of 86 eligible cases were included in our study (62 boys). Among these patients, 61.6% were quadriplegic. Pre-operatively, almost 2/3 of our cases were with GMFCS levels II and III. Mean age at the time of surgery in these cases was 6.2 (3.5-12) years. Pre-op assessment marked 582 target muscles in these patients. Numbers of nerve rootlets tested during SDR procedure were between 52 and 84 across our cases, with a mean of 66.5 ± 6.7/case. Among those tested (5721 in 86 cases), 47.9% (2740) were identified as lower limb-related sensory rootlets. Our protocol successfully differentiated sensory rootlets which were considered to be associated with spasticity of target muscles across all our 86 cases (ranged from 3 to 21). Based on our protocol, 871 dorsal nerve rootlets were sectioned 50%, and 78 were cut 75%. Muscle tone of those target muscles reduced significantly right after SL-SDR procedure (3 weeks post- vs. pre-op, 1.7 ± 0.5 vs. 2.6 ± 0.7). After an intensive rehabilitation program for 19.9 ± 6.0 months, muscle tone continued to decrease to 1.4 ± 0.5. With the reduction of muscle tone, strength of those target muscles in our cases improved dramatically with statistical significance achieved (3.9 ± 1.0 at the time of last follow-up vs. 3.3 ± 0.8 pre-op), and as well as ROM. Increase in GMFCS level and GMFM-66 score was observed at the time of last follow-up with a mean of 0.4 ± 0.6 and 6.1 ± 3.2, respectively, when compared with that at pre-op. In 81 cases with their pre-op GMFCS levels II to V, 27 (33.3%) presented improvement with regard to GMFCS level upgrade, among which 4 (4.9%) even upgraded over 2 levels. Better results with regard to upgrading in level of GMFCS were observed in cases with pre-op levels II and III when compared with those with levels IV and V (24/57 vs. 3/24). Upgrading percentage in cases younger than 6 years at surgery was significantly greater than in those older (23/56 vs. 4/25). Cases with their pre-op GMFM-66 score ≥ 50 had greater score increase of GMFM-66 when compared with those less (7.1 ± 3.4 vs. 5.1 ± 2.8). In the meanwhile, better score improvement was revealed in cases when SDR performed at younger age (6.9 ± 3.3 in case ≤ 6 years vs. 4.7 ± 2.7 in case > 6 years). No permanent surgery-related complications were recorded in the current study. CONCLUSION SL-SDR when guided by our newly modified rhizotomy protocol was still feasible to treat pediatric CP cases with spastic quadriplegia and diplegia. Cases in this condition could benefit from such a procedure when followed by our intensive rehabilitation program with regard to their motor function.
Collapse
Affiliation(s)
- Qijia Zhan
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xidan Yu
- Department of Rehabilitation Medicine, Shanghai Rehabilitation and Vocational Training Center for the Disabled, Shanghai, China
| | - Wenbin Jiang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Shen
- Department of Rehabilitation Medicine, Shanghai Rehabilitation and Vocational Training Center for the Disabled, Shanghai, China
| | - Shuyun Jiang
- grid.412540.60000 0001 2372 7462Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rong Mei
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junlu Wang
- grid.16821.3c0000 0004 0368 8293Department of Neurosurgery, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
7
|
Chen BPJ, Wang KK, Novacheck TF. Selective Dorsal Rhizotomy for the Treatment of Gait Dysfunction in Cerebral Palsy: A Critical Analysis Review. JBJS Rev 2019; 7:e3. [PMID: 31725025 DOI: 10.2106/jbjs.rvw.19.00020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Brian Po-Jung Chen
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota.,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Kemble K Wang
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota.,Department of Orthopedic Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Tom F Novacheck
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, Minnesota.,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
8
|
Velnar T, Spazzapan P, Rodi Z, Kos N, Bosnjak R. Selective dorsal rhizotomy in cerebral palsy spasticity - a newly established operative technique in Slovenia: A case report and review of literature. World J Clin Cases 2019. [DOI: 10.12998/wjge.v7.i10.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
9
|
Velnar T, Spazzapan P, Rodi Z, Kos N, Bosnjak R. Selective dorsal rhizotomy in cerebral palsy spasticity - a newly established operative technique in Slovenia: A case report and review of literature. World J Clin Cases 2019; 7:1133-1141. [PMID: 31183344 PMCID: PMC6547316 DOI: 10.12998/wjcc.v7.i10.1133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spasticity affects a large number of children, mainly in the setting of cerebral palsy, however, only a few paediatric neurosurgeons deal with this problem. This is mainly due to the fact that until 1979, when Fasano has published the first series of selective dorsal rhizotomy (SDR), neurosurgeons were able to provide such children only a modest help. The therapy of spasticity has made a great progress since then. Today, peroral drugs, intramuscular and intrathecal medicines are available, that may limit the effects of the disease. In addition, surgical treatment is gaining importance, appearing in the form of deep brain stimulation, peripheral nerve procedures and SDR. All these options offer the affected children good opportunities of improving the quality of life.
CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy. Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles. Then, the SDR was made.
CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.
Collapse
Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- AMEU-ECM Maribor, Ljubljana 1000, Slovenia
| | - Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Zoran Rodi
- Department of Neurophysiology, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Natasa Kos
- Medical Rehabilitation Unit, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| |
Collapse
|