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Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation

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Abstract

Introduction

Neurosurgical treatments for spasticity in children include the traditional selective dorsal rhizotomy (SDR) and intrathecal baclofen pumps (ITBPs), which have been widely used in the past decade as an attractive alternative. The purpose of the study was to examine and compare the outcomes of these two procedures in the treatment of children with severe spasticity.

Materials and methods

A consecutive series of 71 children who underwent SDR for treatment of spasticity was compared with a group of 71 children matched by age and preoperative score on the Gross Motor Function Classification System (GMFCS) who underwent ITBP placement. Change in GMFCS score, lower-extremity tone (based on the Modified Ashworth–Bohannon Scale), and lower-extremity passive range of movement (PROM) at 1 year as well as the need for subsequent orthopedic procedures and parents’ satisfaction were selected as outcome measures.

Results

At 1 year, both SDR and ITBP decreased tone, increased PROM, and improved function. Both procedures resulted in a high degree of patient satisfaction. Compared with ITBP, SDR provided a larger magnitude of improvement in tone (−2.52 vs −1.23, p < 0.0001), PROM (−0.77 vs −0.39, p = 0.0138), and gross motor function (−0.66 vs −0.08, p < 0.0001). In addition, fewer patients in the SDR group required subsequent orthopedic procedures (19.1 vs 40.8%, p = 0.0106).

Conclusions

For children with moderate to severe spasticity, SDR and ITBP are both effective surgical treatments. Our results indicate SDR is more effective in reducing the degree of spasticity and improving function than ITBP is in this group of patients.

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References

  1. Albright AL (1996) Baclofen in the treatment of cerebral palsy. J Child Neurol 11:77–83

    PubMed  CAS  Google Scholar 

  2. Albright AL, Gilmartin R, Swift D, Krach LE, Ivanhoe CB, McLaughlin JF (2003) Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin. J Neurosurg 98:291–295

    PubMed  CAS  Google Scholar 

  3. Armstrong RW, Steinbok P, Cochrane DD, Kube SD, Fife SE, Farrell K (1997) Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin. J Neurosurg 87:409–414

    PubMed  CAS  Google Scholar 

  4. Engsberg JR, Olree KS, Ross SA, Park TS (1998) Spasticity and strength changes as a function of selective dorsal rhizotomy. J Neurosurg 88:1020–1026

    PubMed  CAS  Google Scholar 

  5. Fasano VA, Urciuoli R, Broggi G, Barolat-Romana G, Benech F, Ivaldi A, Sguazzi A (1977) New aspects in the surgical treatment of cerebral palsy. Acta Neurochir Suppl (Wien) 24:53–57

    Google Scholar 

  6. Gerszten PC, Albright AL, Johnstone GF (1998) Intrathecal baclofen infusion and subsequent orthopedic surgery in patients with spastic cerebral palsy. J Neurosurg 88:1009–1013

    PubMed  CAS  Google Scholar 

  7. Giuliani CA (1991) Dorsal rhizotomy for children with cerebral palsy: support for concepts of motor control. Phys Ther 71:248–259

    PubMed  CAS  Google Scholar 

  8. McLaughlin J, Bjornson K, Temkin N, Steinbok P, Wright V, Reiner A, Roberts T, Drake J, O’Donnell M, Rosenbaum P, Barber J, Ferrel A (2002) Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol 44:17–25

    Article  PubMed  Google Scholar 

  9. Mittal S, Farmer JP, Al-Atassi B, Gibis J, Kennedy E, Galli C, Courchesnes G, Poulin C, Cantin MA, Benaroch TE (2002) Long-term functional outcome after selective posterior rhizotomy. J Neurosurg 97:315–325

    PubMed  Google Scholar 

  10. Mittal S, Farmer JP, Al-Atassi B, Montpetit K, Gervais N, Poulin C, Benaroch TE, Cantin MA (2002) Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure. J Neurosurg 97:510–518

    PubMed  Google Scholar 

  11. Müller H, Zierski J, Dralle D (1988) Pharmacokinetics of intrathecal baclofen. In: Müller H, Zierski J, Penn R (eds) Local-spinal therapy of spasticity. Springer, New York, pp 223–226

    Google Scholar 

  12. O’Brien DF, Park TS, Puglisi JA, Collins DR, Leuthardt EC, Leonard JR (2005) Orthopedic surgery after selective dorsal rhizotomy for spastic diplegia in relation to ambulatory status and age. J Neurosurg 103:5–9

    PubMed  Google Scholar 

  13. Ochs G, Struppler A, Meyerson BA, Linderoth B, Gybels J, Gardner BP, Teddy P, Jamous A, Weinmann P (1989) Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study. J Neurol Neurosurg Psychiatry 52:933–939

    Article  PubMed  CAS  Google Scholar 

  14. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223

    Article  PubMed  CAS  Google Scholar 

  15. Park TS, Owen JH (1992) Surgical management of spastic diplegia in cerebral palsy. N Engl J Med 326:745–749

    Article  PubMed  CAS  Google Scholar 

  16. Peacock WJ, Nuwer MR, Staudt LA (1994) Dorsal rhizotomy: to monitor or not to monitor? J Neurosurg 80:769–772

    PubMed  CAS  Google Scholar 

  17. Penn RD (1992) Intrathecal baclofen for spasticity of spinal origin: seven years of experience. J Neurosurg 77:236–240

    PubMed  CAS  Google Scholar 

  18. Plassat R, Perrouin Verbe B, Menei P, Menegalli D, Mathe JF, Richard I (2004) Treatment of spasticity with intrathecal Baclofen administration: long-term follow-up, review of 40 patients. Spinal Cord 42:686–693

    Article  PubMed  CAS  Google Scholar 

  19. Rawicki B (1999) Treatment of cerebral origin spasticity with continuous intrathecal baclofen delivered via an implantable pump: long-term follow-up review of 18 patients. J Neurosurg 91:733–736

    PubMed  CAS  Google Scholar 

  20. Sherrington C (1898) Decerebrate rigidity, and reflex coordination of movements. J Physiol 22:319–332

    PubMed  CAS  Google Scholar 

  21. Subramanian N, Vaughan CL, Peter JC, Arens LJ (1998) Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity. J Neurosurg 88:1014–1019

    PubMed  CAS  Google Scholar 

  22. Vanek ZF, Menkes JH (2005) Spasticity. e-Medicine

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Acknowledgments

We thank Kristin Kraus for her editorial assistance in preparing this paper.

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Authors and Affiliations

  1. Departments of Neurosurgery and Physical Medicine and Rehabilitation, Primary Children’s Medical Center, University of Utah, Salt Lake City, UT, USA

    Peter Kan, Judith Gooch, Aminullah Amini, Diana Ploeger, Barbara Grams, Wende Oberg, Sara Simonsen, Marion Walker & John Kestle

  2. Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children’s Medical Center, University of Utah, 100 N. Medical Drive, Salt Lake City, UT, 84113, USA

    John Kestle

Authors
  1. Peter Kan
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  2. Judith Gooch
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  3. Aminullah Amini
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  4. Diana Ploeger
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  5. Barbara Grams
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  6. Wende Oberg
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  7. Sara Simonsen
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  8. Marion Walker
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  9. John Kestle
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Correspondence to John Kestle.

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Kan, P., Gooch, J., Amini, A. et al. Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation. Childs Nerv Syst 24, 239–243 (2008). https://doi.org/10.1007/s00381-007-0457-8

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  • DOI: https://doi.org/10.1007/s00381-007-0457-8

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