gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Selective dorsal rhizotomy for the treatment of children with cerebral palsy

Meeting Abstract

  • H. Baechli - Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
  • E. Rutz - Kinderorthopädie, Universitätskinderspital Basel (UKBB), Basel, Schweiz
  • F. Frei - Kinderanästhesie, Universitätskinderspital Basel (UKBB), Basel, Schweiz
  • S.E. Ryhult - Kinderanästhesie, Universitätskinderspital Basel (UKBB), Basel, Schweiz
  • E. Duitmann - Kinderanästhesie, Universitätskinderspital Basel (UKBB), Basel, Schweiz
  • P. Weber - Neuropädiatrie, Universitätskinderspital Basel (UKBB), Basel, Schweiz
  • R. Brunner - Kinderorthopädie, Universitätskinderspital Basel (UKBB), Basel, Schweiz

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.08.08

DOI: 10.3205/11dgnc164, URN: urn:nbn:de:0183-11dgnc1642

Published: April 28, 2011

© 2011 Baechli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Children with cerebral palsy may suffer from severe spasticity which reduces their quality of life. There is no consensus guidance on the management of spasticity. Selective dorsal rhizotomy (SDR) with partial cutting of the dorsal roots from L2 to S1 is a therapeutic neurosurgical option. We present patients, who have had SDR and review decision making, changing biomechanics and patient outcomes.

Methods: All patients suffered from spastic diplegia. In cases where the decision to proceed with SDR was unclear, the patients were tested with a temporary intrathecal lumbar catheter with an external baclofen pump. All operations were performed by the same neurosurgeon with a multi-level laminotomy, except for 1 case (one level). The degree of spasticity was graded using the Ashworth Scale and the motor function using the Gross Motor Function Classification System (GMFCS). Biomechanics were examined in our gait laboratory with video analysis, hip, knee and foot kinematics, electromyography (EMG) and gait velocity. Intraoperative spinal cord monitoring was performed. Sensory roots were divided into rootlets which were singly stimulated with rhizotomy hooks at 20 HZ for 1 second with 0.02 msec2 pulses and a current of 10mA. Electrical and clinical muscle contractions were recorded. Rootlets with the greatest abnormalities were cut, whole cutting rate was less than 40 percent. After surgery, all children received intensive physiotherapy.

Results: We included 17 patients aged between 5 and 26 years (mean 11.8 years). GMFCS scores ranged from 2 to 4. 5 of these were tested pre-operatively with an external baclofen pump. Functional improvements were noted in all patients with a decrease in muscle tone and improvements in gait parameters. In addition, increased motor function in the upper limbs was noted. 9 patients had orthopaedic surgery prior to SDR, 5 of whom required further corrections 1 year later.

Conclusions: SDR is an effective procedure for reducing long-lasting severe spasticity. Patient selection is important and requires a multidisciplinary approach. Managing muscle tone and normalizing biomechanics with a combination of neurosurgery and orthopaedic surgery is critical in achieving good results.