Morota Nobuhito
Department of Neurosurgery, Kitasato University Hospital, Minami-Ku, Sagamihara, Japan.
Adv Tech Stand Neurosurg. 2025;51:43-52. doi: 10.1007/978-3-031-86441-4_4.
Spasticity, characterized by muscle hypertonia, in children poses long-term challenges, leading to motor dysfunction, joint contractures, and a decline in overall quality of life (QOL). This underscores the critical need for effective spasticity management in disabled children. Various interventions, including oral medications, neurorehabilitation, and surgical procedures, have been used in the management of childhood spasticity. Dorsal rhizotomy, a neurosurgical intervention, plays a vital role in this context, selectively and functionally severing roots/rootlets to manage spasticity. Treatment modalities for spasticity encompass basic and active management, with interventions like dorsal rhizotomy, intrathecal baclofen infusion (ITB), and local injection of botulinum toxin (BTX). A strategic approach involves a "spasticity first" policy, prioritizing spasticity reduction, followed by active management and functional improvement through neurorehabilitation and orthopedic surgery. Comparative assessment of treatments, considering factors like age and joint involvement, guides the selection of interventions. Dorsal rhizotomy stands out for its sustainable and cost-effective reduction of spasticity, offering broad applicability across severity levels and diverse pathologies. Despite its efficacy, dorsal rhizotomy has limitations, including its invasiveness, irreversible nature, and the need for postoperative lifelong neurorehabilitation. Careful patient selection by a multidisciplinary spasticity clinic is crucial. The procedure's distinctive role, effectiveness, and cost-effectiveness place dorsal rhizotomy as a valuable tool in comprehensive childhood spasticity management.
痉挛以肌肉张力亢进为特征，在儿童中会带来长期挑战，导致运动功能障碍、关节挛缩以及整体生活质量（QOL）下降。这凸显了对残疾儿童进行有效痉挛管理的迫切需求。包括口服药物、神经康复和外科手术在内的各种干预措施已被用于儿童痉挛的管理。背根切断术作为一种神经外科干预措施，在这方面发挥着至关重要的作用，它选择性地、功能性地切断神经根/小根以管理痉挛。痉挛的治疗方式包括基础管理和积极管理，干预措施如背根切断术、鞘内注射巴氯芬（ITB）和局部注射肉毒杆菌毒素（BTX）。一种策略性方法涉及“痉挛优先”政策，优先降低痉挛，随后通过神经康复和矫形外科进行积极管理和功能改善。考虑年龄和关节受累等因素对治疗进行比较评估，可指导干预措施的选择。背根切断术因其可持续且经济有效地降低痉挛而脱颖而出，在不同严重程度和多种病理情况下都具有广泛适用性。尽管背根切断术有疗效，但也有局限性，包括其侵入性、不可逆性以及术后需要终身神经康复。由多学科痉挛诊所仔细选择患者至关重要。该手术独特的作用、有效性和成本效益使其成为儿童痉挛综合管理中的一种有价值的工具。
