Veerbeek Berendina E, Lamberts Robert P, Fieggen A Graham, Mankahla Ncedile, de Villiers Richard V P, Botha Elsabe, Langerak Nelleke G
1Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town.
2Department of Surgical Sciences, Division of Orthopaedic Surgery, Stellenbosch University, Cape Town; and.
J Neurosurg Spine. 2020 Oct 16;34(2):228-235. doi: 10.3171/2020.6.SPINE20751. Print 2021 Feb 1.
The main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR.
This is a 9-year follow-up study with data collection conducted in 2008 and 2017. Radiographs were assessed for the degree of scoliosis, thoracic kyphosis and lumbar lordosis curvatures, and prevalence of spondylolysis and spondylolisthesis, while level of pain and disability was determined with a self-developed questionnaire and the Oswestry Disability Index (ODI) questionnaire, respectively.
Twenty-five participants were included (15 males; median age 35.9 years, IQR 34.3-41.5 years), with a follow-up time after SDR ranging from 25 to 35 years. No clinically relevant changes were found for spinal curvatures, spondylolysis and spondylolisthesis, perceived pain frequency, and ODI scores between 2008 and 2017. While the prevalence of spondylolysis was 44%, spondylolisthesis was found in 20% (of whom 15% were grade I and 5% grade II), lumbar hyperlordosis was found in 32%, thoracic hyperkyphosis in 4%, and scoliosis in 20%. The Cobb angle was < 25°, and no patient required surgery for scoliosis. In addition, the low back was reported as the most common site of pain, with 28% of the adults with CP having daily pain. This resulted in 80% of the cohort indicating none or minimal disability due to pain based on the ODI. The only correlation found was between hyperkyphosis and female gender.
At follow-up more than 25 years after SDR, no progression in spinal abnormalities, level of pain, and disability was found when compared with findings 15 years after SDR. The prevalence of scoliosis, thoracic hyperkyphosis, and lumbar hyperlordosis was within the range reported for adults with CP, while spondylolysis and spondylolisthesis occurred more often than would be expected. It is difficult, however, to establish the role of SDR in this finding, given the limited data on the natural history of CP. Despite the encouraging outcome of this long-term follow-up study after SDR, it is important to continue monitoring adults with CP during the aging process.
选择性背根切断术（SDR）的主要目的是减轻被诊断为脑瘫（CP）和痉挛性双侧瘫的儿童下肢的痉挛。发生脊柱异常和疼痛的可能性令人担忧，尤其是在老龄化的CP人群中。因此，本研究的目的是评估CP成人患者在SDR超过25年后的脊柱异常、疼痛程度和残疾情况（由于背痛或腿痛），以及与参与者特征的关联。
这是一项为期9年的随访研究，于2008年和2017年进行数据收集。评估X线片的脊柱侧弯程度、胸椎后凸和腰椎前凸曲度，以及椎弓峡部裂和椎体滑脱的患病率，同时分别通过自行编制的问卷和奥斯威斯残疾指数（ODI）问卷确定疼痛程度和残疾情况。
纳入了25名参与者（15名男性；中位年龄35.9岁，四分位间距34.3 - 41.5岁），SDR后的随访时间为25至35年。2008年至2017年期间，脊柱曲度、椎弓峡部裂和椎体滑脱、感知疼痛频率和ODI评分均未发现临床相关变化。椎弓峡部裂的患病率为44%，椎体滑脱的发生率为20%（其中I级为15%，II级为5%），腰椎前凸过大的发生率为32%，胸椎后凸过大的发生率为4%，脊柱侧弯的发生率为20%。Cobb角<25°，没有患者因脊柱侧弯需要手术。此外，下背部被报告为最常见的疼痛部位，28%的CP成人患者每天都有疼痛。这导致80%的队列表示基于ODI，因疼痛导致的残疾为无或极小。唯一发现的相关性是后凸过大与女性性别之间的关联。
在SDR超过25年后的随访中，与SDR后15年的结果相比，未发现脊柱异常、疼痛程度和残疾情况有进展。脊柱侧弯、胸椎后凸过大和腰椎前凸过大的患病率在CP成人患者报告的范围内，而椎弓峡部裂和椎体滑脱的发生率比预期的更常见。然而，鉴于CP自然病史的数据有限，很难确定SDR在这一发现中的作用。尽管这项SDR后的长期随访研究结果令人鼓舞，但在老龄化过程中继续监测CP成人患者仍然很重要。
