School of Medicine, National University of Ireland Galway, Galway, Republic of Ireland.
Division of Neurosurgery, University of Ottawa, Ottawa, ON, Canada.
Adv Tech Stand Neurosurg. 2022;45:379-403. doi: 10.1007/978-3-030-99166-1_13.
Neurosurgical indications and interventions provided in the management of spasticity have evolved significantly over time. Selective dorsal rhizotomy (SDR) and intrathecal baclofen (ITB) pumps have been used to improve mobility, reduce lower extremity spasticity, and increase quality of life in patients with various diagnoses.
Studies describing ITB and SDR outcomes in adult and pediatric patients were identified from Medline and Embase databases. Only publications between January 1990 to January 2021 were included. Combinations of search terms 'Selective Dorsal Rhizotomy', 'Selective Posterior Rhizotomy', 'functional posterior rhizotomy', 'intrathecal baclofen pump', and 'spasticity' were used. Only studies in English language and those that included parameters for lower extremity outcome (i.e., spasticity, ambulation) were included. Only studies describing follow-up 12 months or greater were included. Case reports, reviews without primary data, or inaccessible publications were excluded.
Two hundred and ninety publications between January 1990 to January 2021 were identified. Of these, 62 fit inclusion and exclusion criteria for a total of 1291 adult and 2263 patients. Etiologies in adult and pediatric populations varied substantially with multiple sclerosis, cerebral palsy, and trauma comprising the majority of causes for spasticity in adult patients. In pediatric patients, cerebral palsy was the predominant etiology of spasticity. While outcomes after SDR and ITB varied, both are effective for long-term tone reduction. SDR appeared to have a greater effect on function compared to baseline when comparing relatively similar subgroups. The complication rates for either intervention were significant; ITB had a much greater incidence of wound and hardware adverse events, whereas SDR was associated with a not insignificant incidence of new bladder or sensory deficit.
ITB and SDR have demonstrated efficacy and utility for tone reduction in a variety of conditions. The selection of a specific intervention may have a variety of determining features including the etiology of spasticity, age of patient, as well as balancing benefit and complication profiles of each technique. Appropriate patient selection is essential for providing optimal patient outcomes.
神经外科在痉挛管理方面的适应证和干预措施随着时间的推移发生了显著变化。选择性脊神经后根切断术（SDR）和鞘内巴氯芬泵（ITB）已被用于改善运动能力、降低下肢痉挛程度并提高各种诊断患者的生活质量。
从 Medline 和 Embase 数据库中确定了描述成人和儿科患者 ITB 和 SDR 结果的研究。仅纳入 1990 年 1 月至 2021 年 1 月期间的出版物。使用了“选择性脊神经后根切断术”、“选择性后根切断术”、“功能性后根切断术”、“鞘内巴氯芬泵”和“痉挛”等搜索词组合。仅纳入英语语言的研究以及包含下肢结果参数（即痉挛、步行）的研究。仅纳入随访 12 个月或以上的研究。排除病例报告、无原始数据的综述或无法获取的出版物。
1990 年 1 月至 2021 年 1 月期间共确定了 290 篇出版物。其中，62 篇符合纳入和排除标准，共纳入 1291 例成人和 2263 例儿科患者。成人和儿科人群的病因差异很大，多发性硬化症、脑瘫和创伤构成了成人患者痉挛的主要原因。在儿科患者中，脑瘫是痉挛的主要病因。虽然 SDR 和 ITB 的结果有所不同，但两者均能有效长期降低肌张力。与基线相比，SDR 在比较相对相似的亚组时，对功能的影响更大。两种干预措施的并发症发生率都很高；ITB 出现伤口和硬件不良事件的发生率更高，而 SDR 则与相当大的新膀胱或感觉缺陷发生率相关。
ITB 和 SDR 已证明在多种情况下降低肌张力的疗效和实用性。特定干预措施的选择可能具有多种决定因素，包括痉挛的病因、患者年龄以及平衡每种技术的益处和并发症特征。适当的患者选择对于提供最佳的患者结果至关重要。
