Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China.
Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
Acta Neurochir (Wien). 2024 Feb 26;166(1):108. doi: 10.1007/s00701-024-06010-4.
This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR).
A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2. Muscle tone and motor function were assessed before the operation, at short-term follow-up and at the last follow-up after SDR. Additionally, intraoperative neurophysiological monitoring data were reviewed.
The study comprised 20 eligible cases, where, prior to surgery, 35 quadriceps muscles exhibited spasticity exceeding modified Ashworth Scale grade 2. Following short-term and mid-term follow-up, specifically an average duration of 11 ± 2 days and 1511 ± 210 days after SDR, it was observed that muscle tension in adductors, hamstrings, gastrocnemius, and soleus decreased significantly. This reduction was accompanied by a decrease in quadriceps muscle tone in 24 out of 35 muscles (68.6%). Furthermore, the study found that intraoperative electrophysiological parameters can predict postoperative spasticity relief in the quadriceps. The triggered electromyographic (EMG) output of the transected sensory root/rootlets after single-pulse stimulation revealed that the higher the EMG amplitudes in quadriceps, the greater the likelihood of postoperative decrease in quadriceps muscle tension.
SDR demonstrates the potential to reduce muscle spasticity in lower extremities in children diagnosed with CP, including a notable impact on quadriceps spasticity even they are not targeted in SDR. The utilization of intraoperative neurophysiological monitoring data enhances the predictability of quadriceps spasticity reduction following SDR.
本研究旨在评估选择性脊神经后根切断术（SDR）治疗痉挛型脑瘫（CP）患儿股四头肌痉挛的潜在缓解效果。
回顾性分析 2018 年 7 月至 2020 年 9 月在上海儿童医学中心神经外科行 SDR 的 CP 痉挛患儿的临床资料。纳入标准：股四头肌痉挛改良 Ashworth 量表（MAS）分级>2 级。分别于术前、短期随访（SDR 后平均 11±2d）及末次随访（SDR 后平均 1511±210d）评估肌肉张力和运动功能，并分析术中神经电生理监测数据。
共 20 例患儿纳入研究，术前 35 块股四头肌均存在 MAS 分级>2 级的痉挛。短期和中短期随访时（SDR 后平均 11±2d 和 1511±210d），内收肌、腘绳肌、腓肠肌及比目鱼肌的肌张力均明显下降，35 块股四头肌中 24 块（68.6%）的肌张力下降。术中电生理参数可以预测术后股四头肌痉挛缓解情况，体感诱发电位（SEP）和运动诱发电位（MEP）监测下切断感觉根/根丝的单刺激诱发肌电图（EMG）输出，发现术后股四头肌肌张力下降与 EMG 振幅之间存在显著相关性，EMG 振幅越高，术后股四头肌张力下降的可能性越大。
SDR 可降低 CP 患儿下肢肌肉痉挛程度，对非目标肌肉（股四头肌）也有明显的缓解作用。术中神经电生理监测数据可提高 SDR 后股四头肌痉挛缓解的预测性。
