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Brain Science Advances 2020, 6(1): 42-55 https://doi.org/10.26599/BSA.2020.9050007
Review Article | Open Access | Issue | Published: 17 July 2020

The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR)

Show Author's Information Qi Sun1,§,  Wenling Huang2,§,  Bowen Deng1,  Jingpei Ren1,  Yi Zhao1,  Xiaohong Mu1( ),  Lin Xu1( )
Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
Department of Gynaecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China

§ These authors contributed equally to this work.

Keywords:
spasticity, selective dorsal rhizotomy (SDR), cerebral palsy (CP), complications, technical advance
Cite this article:
Sun Q, Huang W, Deng B, et al. The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR). Brain Science Advances, 2020, 6(1): 42-55. https://doi.org/10.26599/BSA.2020.9050007
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Abstract Full text About this article

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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About this article

The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR)

Show Author's information Qi Sun1,§, Wenling Huang2,§, Bowen Deng1, Jingpei Ren1, Yi Zhao1, Xiaohong Mu1( ), Lin Xu1( )
Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
Department of Gynaecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China

§ These authors contributed equally to this work.

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.

Keywords: spasticity, selective dorsal rhizotomy (SDR), cerebral palsy (CP), complications, technical advance

References(51)

[1]
M Stavsky, O Mor, SA Mastrolia, et al. Cerebral palsy-trends in epidemiology and recent development in prenatal mechanisms of disease, treatment, and prevention. Front Pediatr. 2017, 5: 21.
Google Scholar
[2]
K Aquilina, D Graham, N Wimalasundera. Selective dorsal rhizotomy: an old treatment re-emerging. Arch Dis Child. 2015, 100(8): 798-802.
Google Scholar
[3]
L Xu, SC Cui, L Zhao, et al. Selective posterior rhizotomy: a novel neuromicrosurgery. Chin Med J Metall Ind. 1990, 7(6): 6-7.
Google Scholar
[4]
AM Houle, O Vernet, R Jednak, et al. Bladder function before and after selective dorsal rhizotomy in children with cerebral palsy. J Urol. 1998, 160(3 Pt 2): 1088-1091.
Google Scholar
[5]
S Grunt, AG Fieggen, RJ Vermeulen, et al. Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature. Dev Med Child Neurol. 2014, 56(4): 302-312.
Google Scholar
[6]
M Peden, K Oyegbite, J Ozanne, et al. World Report on Child Injury Prevention. World Health Organization, 2008.
[7]
J McLaughlin, K Bjornson, N Temkin, et al. Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol. 2002, 44(1): 17-25.
Google Scholar
[8]
JF Funk, A Panthen, MS Bakir, et al. Predictors for the benefit of selective dorsal rhizotomy. Res Dev Disabil. 2015, 37: 127-134.
Google Scholar
[9]
HS Kim, P Steinbok, D Wickenheiser. Predictors of poor outcome after selective dorsal rhizotomy in treatment of spastic cerebral palsy. Childs Nerv Syst. 2006, 22(1): 60-66.
Google Scholar
[10]
RD Nicolini-Panisson, AP Tedesco, MR Folle, et al. Selective dorsal rhizotomy in cerebral palsy: selection criteria and postoperative physical therapy protocols. Rev Paul Pediatr. 2018, 36(1): 9.
Google Scholar
[11]
AI Buizer, PEM van Schie, EAM Bolster, et al. Effect of selective dorsal rhizotomy on daily care and comfort in non-walking children and adolescents with severe spasticity. Eur J Paediatr Neurol. 2017, 21(2): 350-357.
Google Scholar
[12]
TS Park, MB Dobbs, J Cho. Evidence supporting selective dorsal rhizotomy for treatment of spastic cerebral palsy. Cureus. 2018, 10(10): e3466.
Google Scholar
[13]
S Mittal, JP Farmer, B Al-Atassi, et al. Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure. J Neurosurg. 2002, 97(3): 510-518.
Google Scholar
[14]
K Tedroff, K Löwing, E Åström. A prospective cohort study investigating gross motor function, pain, and health-related quality of life 17 years after selective dorsal rhizotomy in cerebral palsy. Dev Med Child Neurol. 2015, 57(5): 484-490.
Google Scholar
[15]
AL Josenby, P Wagner, GB Jarnlo, et al. Functional performance in self-care and mobility after selective dorsal rhizotomy: a 10-year practice-based follow-up study. Dev Med Child Neurol. 2015, 57(3): 286-293.
Google Scholar
[16]
N Floeter, S Lebek, MS Bakir, et al. Changes in hip geometry after selective dorsal rhizotomy in children with cerebral palsy. Hip Int. 2014, 24(6): 638-643.
Google Scholar
[17]
S Silva, P Nowicki, MS Caird, et al. A comparison of hip dislocation rates and hip containment procedures after selective dorsal rhizotomy versus intrathecal baclofen pump insertion in nonambulatory cerebral palsy patients. J Pediatr Orthop. 2012, 32(8): 853-856.
Google Scholar
[18]
T Ailon, R Beauchamp, S Miller, et al. Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy. Childs Nerv Syst. 2015, 31(3): 415-423.
Google Scholar
[19]
ME Munger, N Aldahondo, LE Krach, et al. Long-term outcomes after selective dorsal rhizotomy: a retrospective matched cohort study. Dev Med Child Neurol. 2017, 59(11): 1196-1203.
Google Scholar
[20]
BA MacWilliams, BA Johnson, AL Shuckra, et al. Functional decline in children undergoing selective dorsal rhizotomy after age 10. Dev Med Child Neurol. 2011, 53(8): 717-723.
Google Scholar
[21]
MR Reynolds, WZ Ray, RG Strom, et al. Clinical outcomes after selective dorsal rhizotomy in an adult population. World Neurosurg. 2011, 75(1): 138-144.
Google Scholar
[22]
BR Shuman, M Goudriaan, K Desloovere, et al. Muscle synergies demonstrate only minimal changes after treatment in cerebral palsy. J Neuroeng Rehabil. 2019, 16(1): 46.
Google Scholar
[23]
E Carraro, S Zeme, V Ticcinelli, et al. Multidimensional outcome measure of selective dorsal rhizotomy in spastic cerebral palsy. Eur J Paediatr Neurol. 2014, 18(6): 704-713.
Google Scholar
[24]
JD Golan, JA Hall, G O'Gorman, et al. Spinal deformities following selective dorsal rhizotomy. J Neurosurg. 2007, 106(6 Suppl): 441-449.
Google Scholar
[25]
MB Johnson, L Goldstein, SS Thomas, et al. Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy. J Pediatr Orthop. 2004, 24(5): 529-536.
Google Scholar
[26]
NG Langerak, CL Vaughan, EB Hoffman, et al. Incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective dorsal rhizotomy. Childs Nerv Syst. 2009, 25(12): 1593-1603.
Google Scholar
[27]
ZY Li, JK Zhu, XL Liu. Deformity of lumbar spine after selective dorsal rhizotomy for spastic cerebral palsy. Microsurgery. 2008, 28(1): 10-12.
Google Scholar
[28]
DA Spiegel, RT Loder, KA Alley, et al. Spinal deformity following selective dorsal rhizotomy. J Pediatr Orthop. 2004, 24(1): 30-36.
Google Scholar
[29]
M Turi, V Kalen. The risk of spinal deformity after selective dorsal rhizotomy. J Pediatr Orthop. 2000, 20(1): 104-107.
Google Scholar
[30]
TS Park, JL Liu, C Edwards, et al. Functional outcomes of childhood selective dorsal rhizotomy 20 to 28 years later. Cureus. 2017, 9(5): e1256.
Google Scholar
[31]
SE Koop. Scoliosis in cerebral palsy. Dev Med Child Neurol. 2009, 51(Suppl 4): 92-98.
Google Scholar
[32]
P Steinbok, T Hicdonmez, B Sawatzky, et al. Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg. 2005, 102(4 Suppl): 363-373.
Google Scholar
[33]
S Muquit, A Ammar, L Nasto, et al. Combined selective dorsal rhizotomy and scoliosis correction procedure in patients with cerebral palsy. Eur Spine J. 2016, 25(2): 372-376.
Google Scholar
[34]
T Harada, S Ebara, MM Anwar, et al. The lumbar spine in spastic diplegia. A radiographic study. J Bone Joint Surg Br. 1993, 75(4): 534-537.
Google Scholar
[35]
WL Hennrikus, RK Rosenthal, JR Kasser. Incidence of spondylolisthesis in ambulatory cerebral palsy patients. J Pediatr Orthop. 1993, 13(1): 37-40.
Google Scholar
[36]
JC Peter, EB Hoffman, LJ Arens. Spondylolysis and spondylolisthesis after five-level lumbosacral laminectomy for selective posterior rhizotomy in cerebral palsy. Childs Nerv Syst. 1993, 9(5): 285-287; discussion 287–288.
Google Scholar
[37]
JC Peter, EB Hoffman, LJ Arens, et al. Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy. Childs Nerv Syst. 1990, 6(1): 30-32.
Google Scholar
[38]
L Westbom, A Lundkvist Josenby, P Wagner, et al. Growth in children with cerebral palsy during five years after selective dorsal rhizotomy: a practice-based study. BMC Neurol. 2010, 10: 57.
Google Scholar
[39]
JA Lazareff, PF Valencia Mayoral. Histological differences between rootlets sectioned during selective posterior rhizotomy by two surgical techniques. Acta Neurochir (Wien). 1990, 105(1/2): 35-38.
Google Scholar
[40]
VA Fasano, G Broggi, G Barolat-Romana, et al. Surgical treatment of spasticity in cerebral palsy. Childs Brain. 1978, 4(5): 289-305.
Google Scholar
[41]
WJ Peacock, LJ Arens. Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J. 1982, 62(4): 119-124.
Google Scholar
[42]
JP Farmer, AJ Sabbagh. Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy. Childs Nerv Syst. 2007, 23(9): 991-1002.
Google Scholar
[43]
M Sindou, G Georgoulis. Keyhole interlaminar dorsal rhizotomy for spastic diplegia in cerebral palsy. Acta Neurochir (Wien). 2015, 157(7): 1187-1196.
Google Scholar
[44]
P Steinbok. Selective dorsal rhizotomy for spastic cerebral palsy: a review. Childs Nerv Syst. 2007, 23(9): 981-990.
Google Scholar
[45]
MA Cobb, FA Boop. Replacement laminoplasty in selective dorsal rhizotomy: possible protection against the development of musculoskeletal pain. Pediatr Neurosurg. 1994, 21(4): 237-242.
Google Scholar
[46]
AV Dekopov, AA Tomsky, IO Gaevyi, et al. Long-term outcomes of SDR in various groups of cerebral palsy (CP) patients. Zh Vopr Neirokhir Im N N Burdenko. 2015, 79(6): 29-37.
Google Scholar
[47]
JF Funk, H Haberl. 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(5): 819-825.
Google Scholar
[48]
J Bales, S Apkon, M Osorio, et al. Infra-conus single-level laminectomy for selective dorsal rhizotomy: technical advance. Pediatr Neurosurg. 2016, 51(6): 284-291.
Google Scholar
[49]
B Sitthinamsuwan, L Phonwijit, I Khampalikit, et al. Comparison of efficacy between dorsal root entry zone lesioning and selective dorsal rhizotomy for spasticity of cerebral origin. Acta Neurochir (Wien). 2017, 159(12): 2421-2430.
Google Scholar
[50]
RM Reynolds, RP Morton, ML Walker, et al. Role of dorsal rhizotomy in spinal cord injury-induced spasticity. J Neurosurg Pediatr. 2014, 14(3): 266-270.
Google Scholar
[51]
MA Eppinger, CM Berman, CA Mazzola. Selective dorsal rhizotomy for spastic diplegia secondary to stroke in an adult patient. Surg Neurol Int. 2015, 6: 111.
Google Scholar
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Received: 10 February 2020
Revised: 18 March 2020
Accepted: 30 March 2020
Published: 17 July 2020
Issue date: March 2020

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© The authors 2020

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