Sitthinamsuwan Bunpot, Phonwijit Luckchai, Khampalikit Inthira, Nitising Akkapong, Nunta-Aree Sarun, Suksompong Sirilak
Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Acta Neurochir (Wien). 2017 Dec;159(12):2421-2430. doi: 10.1007/s00701-017-3322-x. Epub 2017 Sep 17.
Severe spasticity adversely affects patient functional status and caregiving. No previous study has compared efficacy between dorsal root entry zone lesioning (DREZL) and selective dorsal rhizotomy (SDR) for reduction of spasticity. This study aimed to investigate the efficacy of DREZL and SDR for attenuating spasticity, and to compare efficacy between these two methods.
All patients who underwent DREZL, SDR, or both for treatment of intractable spasticity caused by cerebral pathology at Siriraj Hospital during 2009 to 2016 were recruited. Severity of spasticity was assessed using Modified Ashworth Scale (MAS) and Adductor Tone Rating Scale (ATRS). Ambulatory status was also evaluated.
Fifteen patients (13 males) with a mean age of 30.3 ± 17.5 years were included. Eight, six, and one patient underwent DREZL, SDR, and combined cervical DREZL and lumbosacral SDR, respectively. Eight of ten patients with preoperative bed-bound status had postoperative improvement in ambulatory status. Spasticity was significantly reduced in the DREZL group (p < 0.001), the SDR group (p < 0.001), and in overall analysis (p < 0.001). SDR was effective in both pediatric and adult spasticity patients. A significantly greater reduction in spasticity as assessed by MAS score (p < 0.001) and ATRS score (p = 0.015) was found in the DREZL group. Transient lower limb weakness was found in a patient who underwent SDR.
DREZL is more effective for reducing spasticity, but is more destructive than SDR. DREZL should be preferred for bed-ridden patients, and SDR for ambulatory patients. Both operations are helpful for improving ambulatory status. Gait improvement was observed only in patients who underwent SDR. Adult patients with spasticity of cerebral origin benefit from SDR.
严重痉挛对患者的功能状态和护理产生不利影响。既往尚无研究比较背根入髓区毁损术（DREZL）与选择性背根切断术（SDR）在减轻痉挛方面的疗效。本研究旨在探讨DREZL和SDR减轻痉挛的疗效，并比较这两种方法的疗效。
纳入2009年至2016年期间在诗里拉吉医院因脑部病变接受DREZL、SDR或两者治疗顽固性痉挛的所有患者。使用改良Ashworth量表（MAS）和内收肌肌张力评定量表（ATRS）评估痉挛严重程度。还评估了步行状态。
纳入15例患者（13例男性），平均年龄30.3±17.5岁。分别有8例、6例和1例患者接受了DREZL、SDR以及颈段DREZL联合腰骶段SDR。术前卧床的10例患者中有8例术后步行状态得到改善。DREZL组（p<0.001）、SDR组（p<0.001）及总体分析（p<0.001）中痉挛均显著减轻。SDR对儿童和成人痉挛患者均有效。DREZL组在MAS评分（p<0.001）和ATRS评分（p=0.015）评估中痉挛减轻更为显著。1例接受SDR的患者出现短暂下肢无力。
DREZL在减轻痉挛方面更有效，但比SDR更具破坏性。卧床患者应首选DREZL，能行走的患者应首选SDR。两种手术均有助于改善步行状态。仅在接受SDR的患者中观察到步态改善。成人脑源性痉挛患者可从SDR中获益。
