Article Text

SELECTIVE DORSAL RHIZOTOMY IN CEREBRAL PALSY: CASE STUDY OF 13 CHILDREN
  1. S D Chandra1,
  2. V Kalra1,
  3. A Singh1,
  4. T Ramachandran1,
  5. R Suresh1
  1. 1Department of Neurology, Government Medical College, Bellary, Karnataka, India

Abstract

Objectives Selective dorsal rhizotomy (SDR) is the established surgical procedure for treating lower-extremity spasticity in children with cerebral palsy. In SDR, afferent sensory nerve fibres are cut whereas efferent motor fibres are preserved. The SDR operation decreases the degree of spasticity and improves motor function with long-lasting beneficial effects for children with spastic diplegia.

Methods The standard technique requires an L1–S1 laminectomy or laminoplasty for dorsal nerve roots exiting at their respective foramina. The procedure was performed in 13 children. We discussed the rationale and outcome after SDR after 6 months. A physiotherapist, paramedical staff and nurses assessed the outcome. The outcome in the form of quality of life after SDR, degree of elimination of spasticity, range of movement and gross motor function scale were assessed.

Results We observed a decrease in spasticity and increased range of motion. Data of the children pre and post-surgery were compared and showed an improvement in parameters of gait. There is much variation in the results in individual children due to the extent of rhizotomies.

Conclusions SDR is the procedure of choice for the treatment of spasticity in spastic diplegia. Apart from this surgical approach, a multidisciplinary team should address the medical, social, psychological, educational and therapeutic needs. Team members should have a goal-oriented approach, understanding and appreciation of contributions from all disciplines. Management should be directed at promoting the child’s social emotional development, communication, education, mobility, maximal independence in activities of daily living and appearance as near normal as possible. SDR resulted in a reduction in spasticity and improvement in muscular function and gait.

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