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selective dorsal rhizotomy

David Graham, Kristian Aquilina, Stephanie Cawker, Simon Paget, Neil Wimalasundera
The management of cerebral palsy (CP) is complex and requires a multidisciplinary approach. Selective dorsal rhizotomy (SDR) is a neurosurgical technique that aims to reduce spasticity in the lower limbs. A minimally invasive approach to SDR involves a single level laminectomy at the conus and utilises intraoperative electromyography (EMG). When combined with physiotherapy, SDR is effective in selected children and has minimal complications. This review discusses the epidemiology of CP and the management using SDR within an integrated multidisciplinary centre...
September 2016: J Spine Surg
James Bales, Susan Apkon, Marisa Osorio, Gregory Kinney, R Aaron Robison, Erin Hooper, Samuel Browd
BACKGROUND/AIMS: Selective dorsal rhizotomy for spastic cerebral palsy is an effective and well-validated surgical approach. Multiple techniques have been described in the past including multiple laminectomies and a single-level laminectomy at the level of the conus. There is considerable technical challenge involved with a single-level laminectomy approach. METHODS: We report here a modification of the single-level laminectomy that selectively analyzes each individual nerve root with electromyography to separate dorsal and ventral nerve roots through comparison of stimulus responses...
2016: Pediatric Neurosurgery
Julia Sharma, Christopher Bonfield, Paul Steinbok
PURPOSE: The aim of this study was to determine the outcomes for children who underwent selective dorsal rhizotomy (SDR) for the treatment of spasticity related to spinal pathology. METHODS: We performed a retrospective review of all cases of SDR at our institution over the last 30 years and identified patients in whom spasticity was attributed to spinal rather than cerebral pathology. We gathered demographic information and recorded functional status and spasticity scores pre-operatively and over long-term follow-up...
August 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
M R Golab, P J Breedon, M Vloeberghs
PURPOSE: This research examines an approach for enhancing the efficiency of spinal surgery utilising the technological capabilities and design functionalities of wearable headsets, in this case Google Glass. The aim was to improve the efficiency of the selective dorsal rhizotomy neurosurgical procedure initially through the use of Glass via an innovative approach to information design for an intraoperative monitoring display. METHODS: Utilising primary and secondary research methods the development of a new electromyography response display for a wearable headset was undertaken...
June 9, 2016: European Spine Journal
Walid A Abdel Ghany, Mohamed Nada, Mahmoud A Mahran, Ahmed Aboud, Moustafa G Mahran, Marwa A A Nasef, Mohamed Gaber, Tamer Sabry, Mohamed H Ibrahim, Mohamed H Taha
BACKGROUND: Children with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities. OBJECTIVE: To assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP. METHODS: Fifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study...
September 2016: Neurosurgery
Laura R Grootveld, Petra E M van Schie, Annemieke I Buizer, R Jeroen Vermeulen, Willem J R van Ouwerkerk, Rob L M Strijers, Jules J G Becher
Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR...
August 2016: Journal of Neurosurgery. Pediatrics
Michael H Schwartz, Adam Rozumalski, Katherine M Steele
AIM: To estimate the impact of dynamic motor control on treatment outcomes in children with cerebral palsy. METHOD: We used multiple regression on a retrospective cohort of 473 ambulatory children with cerebral palsy who underwent conservative treatment, single-level orthopaedic surgery, single-event multi-level orthopaedic surgery, or selective dorsal rhizotomy. Outcomes included gait pattern, gait speed, energy cost of walking, and the Pediatric Outcomes Data Collection Instrument...
April 21, 2016: Developmental Medicine and Child Neurology
Franziska Rumberg, Mustafa Sinan Bakir, William R Taylor, Hannes Haberl, Akosua Sarpong, Ilya Sharankou, Susanne Lebek, Julia F Funk
AIM: Cerebral palsy (CP) is associated with dysfunction of the upper motor neuron and results in balance problems and asymmetry during locomotion. Selective dorsal rhizotomy (SDR) is a surgical procedure that results in reduced afferent neuromotor signals from the lower extremities with the aim of improving gait. Its influence on balance and symmetry has not been assessed. The aim of this prospective cohort study was to evaluate the impact of SDR on balance and symmetry during walking...
2016: PloS One
N K Mazarakis, M H Vloeberghs
PURPOSE: Selective dorsal rhizotomy (SDR) is a surgical technique used to treat spasticity in children secondary to cerebral palsy (CP). METHOD: We report, to the best of our knowledge for the first time, the case of a child who underwent SDR for the management of spasticity secondary to Leigh syndrome. RESULT: SDR resulted in excellent functional outcome with significant improvement in spasticity. This result contributes to the mounting evidence that SDR could be used to alleviate spasticity secondary not only to CP but also to other pathologies as well...
September 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Julia Franziska Funk, Hannes Haberl
PURPOSE: Selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy (CP) and is performed either through a lumbosacral multilevel laminectomy or a single-level laminectomy at the medullary conus. Spinal interventions generally involve the risk of subsequent instability depending on the extent of structural weakening. Destabilizing spasticity in CP might further increase this risk for both options. Laminoplasty is frequently applied to reduce instability through anatomical restoration, although the unavoidable interruption of interspinous ligaments might be a reason for inconsistent results...
May 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Abhiram V Gande, Srinivas Chivukula, John J Moossy, William Rothfus, Vikas Agarwal, Michael B Horowitz, Paul A Gardner
OBJECT Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. The long-term efficacy of cervical dorsal root rhizotomy (CDR) in the management of ON has not been well described. The authors reviewed their 14-year experience with CDR to assess pain relief and functional outcomes in patients with medically refractory ON. METHODS A retrospective chart review of 75 ON patients who underwent cervical dorsal root rhizotomy, from 1998 to 2012, was performed...
July 2016: Journal of Neurosurgery
Genying Zhu, Mouwang Zhou, Wenting Wang, Fanshuo Zeng
Spinal cord injury results not only in motor and sensory dysfunctions, but also in loss of normal urinary bladder functions. A number of clinical studies were focused on the strategies for improvement of functions of the bladder. Completely dorsal root rhizotomy or selective specific S2-4 dorsal root rhizotomy suppress autonomic hyper-reflexia but have the same defects: it could cause detrusor and sphincter over-relaxation and loss of reflexive erection in males. So precise operation needs to be considered...
February 2016: Medical Hypotheses
B Sitthinamsuwan, S Nunta-Aree
This article aims to describe the roles, operative strategies and outcomes of neuroablative procedures in treatment of movement disorders related to cerebral palsy (CP). The authors reviewed relevant medical literatures concerning ablative neurosurgical procedures for CP. Neurosurgery is an appropriate option for treatment of intractable movement disorders in CP. Destructive therapies can be selectively operated upon, on the brain, spinal cord, nerve root and peripheral nerve. Because all of them carry irreversible properties, presurgical evaluation and decision making for the surgery are critical...
December 2015: Journal of Neurosurgical Sciences
Harshal Ingale, Ismail Ughratdar, Samiul Muquit, Ahmad A Moussa, Michael H Vloeberghs
BACKGROUND: Conventionally, selective dorsal rhizotomy (SDR) has been reserved for ambulant children and implantation of intrathecal baclofen (ITB) pump for non-ambulant children with cerebral palsy. Rather than replacing the ITB pump in selected Gross Motor Function Classification System (GMFCS) grades 4 and 5 children, we elected to undertake SDR instead. We discuss the rationale and outcomes. OBJECTIVES: To assess if children with severe spasticity treated with long-term ITB pump would benefit from SDR as alternative procedure to replacement of ITB pump...
February 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
R Bale
CLINICAL ISSUE: Increasing understanding of the anatomy and physiology of neural structures has led to the development of surgical and percutaneous neurodestructive methods in order to target and destroy various components of afferent nociceptive pathways. The dorsal root ganglia and in particular the ganglia of the autonomous nervous system are targets for radiological interventions. The autonomous nervous system is responsible for the regulation of organ functions, sweating, visceral and blood vessel-associated pain...
October 2015: Der Radiologe
Samiul Muquit, Amr Ammar, Luigi Nasto, Ahmad A Moussa, Hossein Mehdian, Michael H Vloeberghs
UNLABELLED: Intrathecal baclofen (ITB) therapy for spasticity has been suggested to accelerate the development of scoliosis. We present the case of a 17-year-old female patient with cerebral palsy who had ITB therapy from the age of 11 years. During this period, she developed a severe scoliosis measuring 86° from T11 to L4, with pain due to costo-pelvic impingement. Her baclofen pump had reached its end of life and required replacement if ITB therapy was to continue. This coincided with plans for scoliosis corrective surgery...
February 2016: European Spine Journal
G Lombardi, S Musco, J J Wyndaele, G Del Popolo
STUDY DESIGN: Review study. OBJECTIVES: Alternative treatments to oral phosphodiesterase type 5 inhibitors (PDE5Is) in individuals with spinal cord lesions (SCLs) and erectile dysfunction (ED). SETTING: Italy. METHODS: Research clinical trials (1999-2014). RESULTS: Twelve studies were selected. One article documented that 76% of subjects reached satisfactory sexual intercourse (SI) using intracavernosal injection of vasoactive medications (papaverine and prostaglandin E1)...
December 2015: Spinal Cord
Melissa Ann Eppinger, Casey Melissa Berman, Catherine Anne Mazzola
BACKGROUND: Selective dorsal rhizotomy (SDR) is often recommended for children with spastic paraparesis and cerebral palsy. SDR reduces spasticity in the lower extremities for these children with spastic paraplegia. However, SDR is infrequently recommended for adults with spasticity. Spastic diplegia in adult patients can be due to stroke, brain or spinal cord injury from trauma, infection, toxic-metabolic disorders, and other causes. Although rarely considered, SDR is an option for adult patients with spastic diplegia as well...
2015: Surgical Neurology International
J McFall, C Stewart, V Kidgell, N Postans, S Jarvis, R Freeman, A Roberts
This paper presents long term follow up results from 17 children (6 girls, 11 boys, GMFCS levels II-IV), treated by means of selective dorsal rhizotomy (SDR). The particular focus is on the effect of the adolescent growth spurt on patients who had previously undergone SDR. The children were all assessed using 3D gait analysis, in combination with clinical examination at three time points-before SDR surgery (PRE), after SDR surgery when pre-adolescent (POST1) and post-adolescence (POST2). The total follow up period to POST2 was 8 years 6 months for girls and 9 years 5 months for boys...
September 2015: Gait & Posture
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