Effect of selective dorsal rhizotomy on daily care and comfort in non-walking children and adolescents with severe spasticity |
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Authors: | AI Buizer PEM van Schie EAM Bolster WJ van Ouwerkerk RL Strijers LA van de Pol A Stadhouder JG Becher RJ Vermeulen |
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Institution: | 1. Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands;2. Department of Neurosurgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands;3. Department of Clinical Neurophysiology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands;4. Department of Child Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands;5. Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands;6. Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands |
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Abstract: | BackgroundIn non-walking children with severe spasticity, daily care can be difficult and many patients suffer from pain. Selective dorsal rhizotomy (SDR) reduces spasticity in the legs, and therefore has the potential to improve daily care and comfort.AimTo examine effects of SDR on daily care and comfort in non-walking children with severe spasticity due to different underlying neurological conditions.MethodsMedical history, changes in daily care and comfort and satisfaction with outcome were assessed retrospectively in non-walking children who underwent SDR in our center, with a mean follow-up of 1y 7m (range 11m–4y 3m). All eligible patients (n = 24, years 2009–2014) were included.ResultsMean age at SDR was 12y 4m (SD 4y 3m, range 2y 8m–19y 3m). Associated orthopaedic problems were frequent. Seven patients underwent scoliosis correction in the same session. Most improvements were reported in dressing (n = 16), washing (n = 12) and comfort (n = 10). Median score for satisfaction was 7 on a scale of 10 (range 1–9). SDR resulted in reduction of spasticity in leg muscles. In nine patients dystonia was recorded post-operatively, mainly in children with congenital malformations and syndromes.InterpretationSDR is a single event intervention that can improve daily care and comfort in non-walking children with severe spasticity, and can safely be combined with scoliosis correction. Despite the improvements, satisfaction is variable. Careful attention is necessary for risk factors for dystonia, which may be unmasked after SDR. |
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Keywords: | Cerebral palsy Surgery Intervention SDR Scoliosis Pain |
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