Lumbosacral vertically limited selective posterior rhizotomy in children with spastic diplegic cerebral palsy

Bhattacharjee, Suchanda; Purohit, A. K.; Sonylal, E.
July 2007
Journal of Pediatric Neurosciences;Jul-Dec2007, Vol. 2 Issue 2, p104
Academic Journal
OBJECTIVE: This study aims at reduction of harmful resistant spasticity in the lower limbs to produce helpful muscular tone in children with cerebral palsy with minimum necessary ablation in the sensory path of monosynaptic reflex pathway acting at cauda equina. We present here our experience in the management of children harbouring spastic diplegic variant of cerebral palsy. MATERIALS AND METHODS:Vertically limited selective posterior rhizotomy[VL-SPR] was performed in 50 children in the age group of 5 to 20 years. Children who fitted the inclusion criteria were those who were unable to attain or maintain various postures or difficulty to maintain voluntary movements. Children who have developed or having the potential for developing contractures or children with disabling pain or those who did not respond to any other form of therapy. Vertically in the spine only L4 and L5 partial laminectomy is performed and then L5, S1 and if required S2 SPR is performed. Post operatively patients were followed at 3, 6 and 12 months and spasticity as used by modified Ashworth Scale and functional outcome by WeeFIM scoring system. RESULT: In the first twenty cases analysed by Wilcoxon rank-sum test there was a significant improvement of 0.72 (2.11-1.38) at hip adductor, 1.13 (3.16-2.03) at knee flexors and 2.06 (2.6,1-0.55) at ankle plantar flexors with P values <0.008, <0.00008, <0.0000004 respectively post operatively by Modified Ashworth Scale. The WeeFIM score analysis showed an improvement of 13.78 (99.11-85.33). In the other 30 cases the improvement trend was similar to the first 20 cases. Conclusion: From this study we conclude that lumbosacral VL-SPR in children with spastic diplegic variant of cerebral palsy is an economic way of providing a gratifying level of improvement in spasticity and making further management of this developmental disease easier in the little ones.


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