Division of Pediatric Neurosurgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital, 211 E Chicago Ave Ste 1150, Chicago, IL, 60611, USA.
Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Childs Nerv Syst. 2024 Sep;40(9):2835-2842. doi: 10.1007/s00381-024-06479-5. Epub 2024 Jul 3.
Cervicothoracic ventral-dorsal rhizotomy (VDR) is a potential treatment of medically refractory hypertonia in patients who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervicothoracic VDR for the treatment of hypertonia.
Retrospective data analysis was performed for patients that underwent non-selective cervicothoracic VDR between 2022 and 2023. Non-modifiable risk factors, clinical variables, and operative characteristics were collected.
Six patients (three female) were included. Four patients underwent a bilateral C6-T1 VDR, one patient underwent a left C7-T1 VDR, and another underwent a left C6-T1 VDR. Three patients had quadriplegic mixed hypertonia, one patient had quadriplegic spasticity, one patient had triplegic mixed hypertonia, and one patient had mixed hemiplegic hypertonia. The mean difference of proximal upper extremity modified Ashworth scale (mAS) was - 1.4 ± 0.55 (p = 0.002), and - 2.2 ± 0.45 (p < 0.001) for the distal upper extremity. Both patients with independence noted quality of life improvements as well as increased ease with dressing and orthotics fits. Caregivers for the remaining four patients noted improvements in caregiving provision, mainly in dressing, orthotics fit, and ease when transferring.
Cervicothoracic VDR is safe and provides tone control and quality of life improvements in short-term follow-up. It can be considered for the treatment of refractory hypertonia. Larger multicenter studies with longer follow-up are necessary to further determine safety along with long-term functional benefits in these patients.
颈椎胸段腹背根切断术（VDR）是一种治疗对鞘内巴氯芬治疗无效的患者的肌张力障碍的潜在方法，特别是对于那些上肢严重痉挛、功能受限或丧失的患者。本研究通过对接受颈椎胸段 VDR 治疗的肌张力障碍患者进行回顾性队列研究，以突出我们机构的安全性和有效性。
对 2022 年至 2023 年间接受非选择性颈椎胸段 VDR 的患者进行回顾性数据分析。收集不可变的风险因素、临床变量和手术特征。
共纳入 6 例患者（3 例女性）。4 例患者行双侧 C6-T1 VDR，1 例患者行左侧 C7-T1 VDR，1 例患者行左侧 C6-T1 VDR。3 例患者为四肢瘫混合性痉挛，1 例患者为四肢瘫痉挛性，1 例患者为三肢瘫混合性痉挛，1 例患者为混合性偏瘫性痉挛。近端上肢改良 Ashworth 量表（mAS）的平均差值为-1.4±0.55（p=0.002），远端上肢为-2.2±0.45（p<0.001）。2 例有独立性的患者均表示生活质量有所改善，穿衣和矫形器适配更容易。其余 4 例患者的照顾者表示在照顾方面有所改善，主要是在穿衣、矫形器适配和转移方面更容易。
颈椎胸段 VDR 是安全的，可在短期随访中改善肌张力障碍患者的肌肉张力和生活质量。对于难治性肌张力障碍，可考虑采用该方法治疗。需要进行更大规模的多中心研究并进行更长时间的随访，以进一步确定该治疗方法的安全性和长期功能获益。
