Introduction
Methods and materials
Subjects
Criteria for selective dorsal rhizotomy | |
---|---|
1.) | Bilateral spasticity of the lower extremities interfering with walking performance |
2.) | Presence of spasticity (defined as velocity-dependent resistance to passive stretch) in at least six muscle groups of the lower limbs |
3.) | Sufficient force in the quadriceps femoris muscle (squatting at least seven times) and the hip extensors (kneel with extended hips, support for balance allowed) |
4.) | Absence of structural orthopedic deformities or contractures at hip, knee, or ankle |
5.) | Presence of moderate to good selective motor control in the lower limbs |
6.) | Gross motor function classification system (GMFCS) level I, II, or III |
7.) | Good support from parents and rehabilitation setting |
Procedure
Neuroimaging
Case | Gender | GA (weeks) | BW (g) | Age SDR years (mts) | Follow-up years (mts) | MRI classification | Diagnosis | GMFM-66 before SDR | GMFM-66 (mean) after SDR |
---|---|---|---|---|---|---|---|---|---|
1 | F | 30 | 2,000 | 5 (7) | 8 (5) | PVL | PVL | 50.85 | 53.29 |
2 | F | 40 | 2,500 | 5(7) | 9 (0) | PVL | PVL | 47.68 | 49.66 |
3 | F | 40 | 3,450 | 5 (8) | 8 (11) | PVL | PVL | 54.38 | 55.71 |
4 | M | 30 | 1,650 | 6 (8) | 8 (11) | PVL | PVL | 46.91 | 48.32 |
5 | F | 28 | 1,285 | 4 (11) | 7 (10) | PVL | PVL | 50.32 | 54.75 |
6 | M | 26 | 1,000 | 5 (3) | 7 (10) | PVL | PVL | 64.98 | 67.82 |
7 | M | 32 | 2,510 | 5 (1) | 6 (7) | PVL | PVL | 54.15 | 60.38 |
8 | M | 33 | 1,265 | 8 (9) | 5 (1) | PVL | PVL | 47.09 | 55.92 |
9 | M | 26 | 870 | 6 (11) | 3 (11) | PVL | PVL | 50.09 | 54.32 |
10 | M | 26 | 780 | 5 (4) | 3 (0) | PVL | PVL | 52.32 | 62.98 |
11 | F | 41 | 3,060 | 8 (4) | 5 (2) | Hydrocephalus | Congenital hydrocephalus | 55.62 | 56.35 |
12 | M | 27 | 1,020 | 10 (1) | 4 (5) | Hydrocephalus | Congenital hydrocephalus | 68.86 | 68.69 |
13 | M | 40 | 3,300 | 5 (9) | 7 (2) | Normal | Unknown | 65.33 | 67.31 |
14 | M | 34 | 3,155 | 6 (11) | 3 (0) | Normal | Spinal process | 76.75 | 85.15 |
15 | M | 38 | 4,280 | 8 (0) | 2 (7) | Normal | Unknown | 82.99 | 89.70 |
16 | F | 40 | 3,875 | 8 (10) | 1 (7) | Normal | HIV-Encephalo(myelo)pathy | 73.63 | 80.46 |
17 | M | 39 | 4,040 | 6 (7) | 2 (0) | Normal | Unknown | 65.98 | 78.38 |
18 | M | 40 | 3,460 | 6 (5) | 1 (1) | Normal | Unknown | 73.63 | 81.93 |
19 | M | 37 | 3,400 | 3 (11) | 7 (1) | Not classified | Laurence moon syndrome | 47.26 | 83.01 |
Outcome measure
Statistical analysis
Results
Clinical characteristics and level of functioning
Neuroimaging
Normal MRI (n = 6) | PVL (n = 10) | Hydrocephalus (n = 2) | Total (n = 18) | P value | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Range | Mean | SD | Range | Mean | SD | Range | Mean | SD | Range | ||
GMFM-66 before SDR | 73.1a
| 6.7 | 65.3–83.0 | 51.9a
| 5.3 | 46.9–65.0 | 62.2 | 9.4 | 55.6–68.9 | 60.1 | 11.5 | 46.9–83.0 | 0.002 |
Mean GMFM-66 after SDR | 80.5a
| 7.6 | 67.3–89.7 | 56.3a
| 5.9 | 48.3–67.8 | 62.5 | 8.7 | 56.3–68.7 | 65.1 | 13.0 | 48.3–89.7 | 0.003 |
Delta-GMFM-66 | 7.4b
| 3.4 | 2.0–12.4 | 4.4c
| 3.2 | 1.3–10.7 | 0.3b, c
| 0.6 | −0.2–0.7 | 5.0 | 3.7 | −0.2–12.4 | 0.030 |
Normal | Moderate | Severe | |
---|---|---|---|
Ventricular size | 2 (20%) | 8 (80%) | 0 (0%) |
White matter signal intensity | 0 (0%) | 10 (100%) | 0 (0%) |
White matter loss | 1 (10%) | 9 (90%) | 0 (0%) |
Thinning of the corpus callosum | 4 (40%) | 6 (60%) | 0 (0%) |
Cysts | 7 (70%) | 1 (10%) | 2 (20%) |
Gray matter abnormality | 10 (100%) | 0 (0%) | 0 (0%) |
Enlargement of the subarachnoidal space | 10 (100%) | 0 (0%) | 0 (0%) |
Mean | SD | Range | |
Total Score | 10.8 | 1.1 | 8–12 |