Functional outcomes after selective dorsal rhizotomy followed by minimally invasive tendon lengthening procedures in children with spastic cerebral palsy.
Journal
Journal of pediatric orthopedics. Part B
ISSN: 1473-5865
Titre abrégé: J Pediatr Orthop B
Pays: United States
ID NLM: 9300904
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
pubmed:
16
7
2019
medline:
3
6
2020
entrez:
16
7
2019
Statut:
ppublish
Résumé
Many surgical options have been proposed to improve the ambulatory status of children with spastic cerebral palsy (CP), but none have focused on addressing both spasticity and lower extremity tendon contractures. The purpose of this study is to evaluate the results of selective dorsal rhizotomy (SDR) followed by minimally invasive tendon lengthening allowing immediate return to ambulation. Two hundred fifty-five spastic CP patients (who received SDR procedure at an average age of 6.9±2.6 years and tendon lengthening procedure at an average age of 7.2±2.5 years) were retrospectively reviewed. Patients were grouped by the gross motor function classification system (GMFCS) 1-3 and 4-5. Kaplan-Meier analysis and Cox proportional hazard model using a requirement for additional tendon lengthening as an end point were conducted. Tendon lengthening followed SDR at an average of 4.3±10.7 months. On an average of 4.9±1.2 years after tendon lengthening, GMFCS was improved in 28 and maintained in 213 patients, respectively. There was no difference of variables and joint angles between the two GMFCS groups. A repeat tendon lengthening was required in 19 patients. The Kaplan-Meier analysis showed 81% success rate. Cox proportional hazard model identified age at tendon lengthening [hazards ratio (HR), 0.53; 95% confidence interval (CI), 0.37-0.76] and duration between SDR and tendon lengthening of more than 6 months (HR, 2.96; 95% CI, 1.05-8.33) associated with need for a repeat tendon lengthening procedure. Our novel approach of SDR/tendon lengthening results in improved joint angles as well as stable or improved GMFCS. Longer follow-up is necessary to determine if this approach could prolong ambulatory ability and reduced need for more invasive orthopedic surgeries.
Identifiants
pubmed: 31305364
doi: 10.1097/BPB.0000000000000642
pii: 01202412-202001000-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-8Références
Bolster EA, van Schie PE, Becher JG, van Ouwerkerk WJ, Strijers RL, Vermeulen RJ. Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Dev Med Child Neurol. 2013; 55:610–616
Farmer JP, Sabbagh AJ. Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy. Childs Nerv Syst. 2007; 23:991–1002
O’Brien DF, Park TS, Puglisi JA, Collins DR, Leuthardt EC, Leonard JR. Orthopedic surgery after selective dorsal rhizotomy for spastic diplegia in relation to ambulatory status and age. J Neurosurg. 2005; 103:5–9
Park TS, Johnston JM. Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Technical note. Neurosurg Focus. 2006; 21:e7
Saraph V, Zwick EB, Auner C, Schneider F, Steinwender G, Linhart W. Gait improvement surgery in diplegic children: how long do the improvements last?. J Pediatr Orthop. 2005; 25:263–267
Thomason P, Selber P, Graham HK. Single event multilevel surgery in children with bilateral spastic cerebral palsy: a 5 year prospective cohort study. Gait Posture. 2013; 37:23–28
Dudley RW, Parolin M, Gagnon B, Saluja R, Yap R, Montpetit K, et al.Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatr. 2013; 12:142–150
Engsberg JR, Ross SA, Collins DR, Park TS. Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy. J Neurosurg. 2006; 105:8–15
Park TS, Liu JL, Edwards C, Walter DM, Dobbs MB. Functional outcomes of childhood selective dorsal rhizotomy 20 to 28 years later. Cureus. 2017; 9:e1256
Langerak NG, Tam N, Vaughan CL, Fieggen AG, Schwartz MH. Gait status 17-26 years after selective dorsal rhizotomy. Gait Posture. 2012; 35:244–249
Park TS, Edwards C, Liu JL, Walter DM, Dobbs MB. Beneficial effects of childhood selective dorsal rhizotomy in adulthood. Cureus. 2017; 9:e1077
Wang KK, Munger ME, Chen BP, Novacheck TF. Selective dorsal rhizotomy in ambulant children with cerebral palsy. J Child Orthop. 2018; 12:413–427
Grunt S, Fieggen AG, Vermeulen RJ, Becher JG, Langerak NG. Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature. Dev Med Child Neurol. 2014; 56:302–312
Munger ME, Aldahondo N, Krach LE, Novacheck TF, Schwartz MH. Long-term outcomes after selective dorsal rhizotomy: a retrospective matched cohort study. Dev Med Child Neurol. 2017; 59:1196–1203
Grunt S, Becher JG, Vermeulen RJ. Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol. 2011; 53:490–498
Mitsiokapa EA, Mavrogenis AF, Skouteli H, Vrettos SG, Tzanos G, Kanellopoulos AD, et al.Selective percutaneous myofascial lengthening of the lower extremities in children with spastic cerebral palsy. Clin Podiatr Med Surg. 2010; 27:335–343
Rutz E, Baker R, Tirosh O, Brunner R. Are results after single-event multilevel surgery in cerebral palsy durable?. Clin Orthop Relat Res. 2013; 471:1028–1038
Yu S, Rethlefsen SA, Wren TA, Kay RM. Long-term ambulatory change after lower extremity orthopaedic surgery in children with cerebral palsy: a retrospective review. J Pediatr Orthop. 2015; 35:285–289
Rutz E, Tirosh O, Thomason P, Barg A, Graham HK. Stability of the gross motor function classification system after single-event multilevel surgery in children with cerebral palsy. Dev Med Child Neurol. 2012; 54:1109–1113
Godwin EM, Spero CR, Nof L, Rosenthal RR, Echternach JL. The gross motor function classification system for cerebral palsy and single-event multilevel surgery: is there a relationship between level of function and intervention over time?. J Pediatr Orthop. 2009; 29:910–915
Takahashi S, Shrestha A. The vulpius procedure for correction of equinus deformity in patients with hemiplegia. J Bone Joint Surg Br. 2002; 84:978–980
CanChild. Gross motor function classification system-expanded and revised (GMFCS–E&R)2015. https://canchild.ca/en/resources/42-gross-motor-function-classification-system-expanded-revised-gmfcs-e-r. [Accessed 12 November 2018]
Kondo I, Hosokawa K, Iwata M, Oda A, Nomura T, Ikeda K, et al.Effectiveness of selective muscle-release surgery for children with cerebral palsy: longitudinal and stratified analysis. Dev Med Child Neurol. 2004; 46:540–547
Rutz E, Hofmann E, Brunner R. Preoperative botulinum toxin test injections before muscle lengthening in cerebral palsy. J Orthop Sci. 2010; 15:647–653
Tedroff K, Löwing K, Jacobson DN, Åström E. Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy. Dev Med Child Neurol. 2011; 53:724–729
Ross SA, Engsberg JR, Olree KS, Park TS. Quadriceps and hamstring strength changes as a function of selective dorsal rhizotomy surgery and rehabilitation. Pediatr Phys Ther. 2001; 13:2–9
O’Brien DF, Park TS. A review of orthopedic surgeries after selective dorsal rhizotomy. Neurosurg Focus. 2006; 21:e2
Spijker M, Strijers RL, van Ouwerkerk WJ, Becher JG. Disappearance of spasticity after selective dorsal rhizotomy does not prevent muscle shortening in children with cerebral palsy: a case report. J Child Neurol. 2009; 24:625–627
Engsberg JR, Ross SA, Park TS. Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy. J Neurosurg. 1999; 91:727–732
McGinley JL, Dobson F, Ganeshalingam R, Shore BJ, Rutz E, Graham HK. Single-event multilevel surgery for children with cerebral palsy: a systematic review. Dev Med Child Neurol. 2012; 54:117–128
Lamberts RP, Burger M, du Toit J, Langerak NG. A systematic review of the effects of single-event multilevel surgery on gait parameters in children with spastic cerebral palsy. Plos One. 2016; 11:e0164686
Dreher T, Vegvari D, Wolf SI, Geisbüsch A, Gantz S, Wenz W, Braatz F. Development of knee function after hamstring lengthening as a part of multilevel surgery in children with spastic diplegia: a long-term outcome study. J Bone Joint Surg Am. 2012; 94:121–130
Dreher T, Buccoliero T, Wolf SI, Heitzmann D, Gantz S, Braatz F, Wenz W. Long-term results after gastrocnemius-soleus intramuscular aponeurotic recession as a part of multilevel surgery in spastic diplegic cerebral palsy. J Bone Joint Surg Am. 2012; 94:627–637
Yngve DA, Chambers C. Vulpius and Z-lengthening. J Pediatr Orthop. 1996; 16:759–764
Thompson N, Stebbins J, Seniorou M, Wainwright AM, Newham DJ, Theologis TN. The use of minimally invasive techniques in multi-level surgery for children with cerebral palsy: preliminary results. J Bone Joint Surg Br. 2010; 92:1442–1448
Seniorou M, Thompson N, Harrington M, Theologis T. Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy. Gait Posture. 2007; 26:475–481
Carroll KL, Moore KR, Stevens PM. Orthopedic procedures after rhizotomy. J Pediatr Orthop. 1998; 18:69–74
O’Brien DF, Park TS, Puglisi JA, Collins DR, Leuthardt EC. Effect of selective dorsal rhizotomy on need for orthopedic surgery for spastic quadriplegic cerebral palsy: long-term outcome analysis in relation to age. J Neurosurg. 2004; 101:59–63