Adv Tech Stand Neurosurg . 2025:51:65-80. doi: 10.1007/978-3-031-86441-4_6.
Selection of Children with Spasticity Other Than Cerebral Palsy: Indications, Long-Term Outcome, and Exclusion Criteria
Pramath Kakodkar 1, Nooshin Shekari 2, Madhura Thipse 3, Debajyoti Datta 4, Albert Tu 5 6
1Diagnostic and Clinical Pathology, University of Saskatchewan, Saskatoon, SK, Canada.
2Department of Anatomy, Physiology & Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada.
3Department of Clinical Research, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
4Division of Pediatric Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
5Division of Pediatric Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. [email protected].
6Department of Surgery, University of Ottawa, Ottawa, ON, Canada. [email protected].
PMID: 40445341 DOI: 10.1007/978-3-031-86441-4_6
Abstract
Background: Selective dorsal rhizotomy (SDR) has been instrumental in improving functionality and mitigating lower extremity spasticity originating from a myriad of central nervous system (CNS) etiologies. Existing literature on SDR extensively discusses its utility in cerebral palsy (CP)-associated spasticity management. There is a void on the utility and guidance in patient selection for SDR in pediatric patients with non-CP-related spasticity.
Methods: A systematic review was performed on studies describing SDR outcomes in pediatric patients identified from Medline and Embase databases. Publications between January 1970 and August 2023 were included. Combinations of search terms "selective dorsal rhizotomy," "selective posterior rhizotomy," and "spasticity" were utilized. Pediatric patient studies with clinical data on spasticity, ambulation, procedural variables, and follow-up outcomes were included. Articles including patients without cerebral palsy as a primary diagnosis were reviewed in detail for outcomes after intervention.
Results: A total of 114 publications were identified, and of these, 11 fit inclusion criteria for a total of 127 patients. Most common non-CP etiologies for spasticity included hereditary spastic paraparesis (27.8%, n = 34), congenital syndrome (n = 7), and spinal cord injury (21.9%, n = 6). Compared to their baseline, SDR in non-CP-related etiologies demonstrated tone normalization (93%, n = 43 out of 45 patients) in most and improvement in ambulation (49.2%, n = 58 out of 118 patients) in a significant proportion of patients.
Conclusion: This systematic review on SDR in pediatric patients revealed effective spasticity control and improvement in ambulatory functionality in selected patients without cerebral palsy. Appropriate patient selection is keystone in achieving sustained benefits in functionality and quality of life.
Keywords: Non-cerebral-palsy-related spasticity; Pediatric; Rhizotomy; Selection; Selective dorsal rhizotomy; Spasticity.
© 2025. The Author(s), under exclusive license to Springer Nature Switzerland AG.
PubMed Disclaimer
|
50
[Single chapter]https://link.springer.com/chapter/10.1007/978-3-032-07001-2_7
