Neurosciences Department, El Paso Children's Hospital, El Paso, TX, USA.
Department of Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
Acta Neurochir (Wien). 2024 Jul 30;166(1):308. doi: 10.1007/s00701-024-06187-8.
Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP.
The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.
There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.
SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.
脑瘫（CP）是儿童运动功能障碍的最主要原因。选择性脊神经后根切断术（SDR）在长期痉挛控制中起着重要作用。然而，关于 SDR 对术后痉挛治疗需求和中枢神经系统影响以及 CP 患者脊神经根刺激反应的有限数据。
本研究包括 35 例接受 SDR 治疗的患者的运动功能结果、痉挛、巴氯芬剂量变化、肉毒毒素注射频率以及与痉挛相关的矫形手术。我们还报告了在我们机构接受 SDR 的 112 例患者的刺激反应。
在最后一次随访时，粗大运动功能测量（GMFM）-66 评分存在显著差异，仅考虑可走动的儿童时仍然存在，但对于不可走动的儿童则不存在。SDR 后上肢和下肢的 Ashworth 评分均在所有随访点显著降低。SDR 后巴氯芬剂量和肉毒毒素注射需求显著降低，但矫形干预需求无显著差异。总共测试了 5502 根脊神经后根，右侧和腰骶水平的刺激强度降低，等级升高。
SDR 在短期随访期间可改善粗大运动评分，但在术后还可降低巴氯芬剂量和肉毒毒素注射需求。节段性脊神经根的刺激反应增加了有限的现有数据，并加深了我们对 CP 中发生的病理变化的理解。
