Qijia Zhan1, Liang Tang2, Yanyan Wang1, Bo Xiao3, Min Shen4, Shuyun Jiang5, Rong Mei1, Zhibao Lyu6. 1. Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, 355 Luding Rd, Shanghai, China. 2. Rehabilitation Center, Shanghai Children's Hospital, Shanghai Jiao Tong University, 355 Luding Rd, Shanghai, China. 3. Department of Neurosurgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, 355 Luding Rd, Shanghai, China. xiao977@hotmail.com. 4. Rehabilitation Center, Shanghai Rehabilitation and Vocational Training Center for the Disabled, 265 Linyi North Rd, Shanghai, China. 5. Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai, China. 6. Department of General Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, 355 Luding Rd, Shanghai, China.
Abstract
PURPOSE: It still remains challenging to treat CP cases with spastic hemiplegia using SDR via a single-level approach when guided by the traditional EMG response grading system. Our aim was to assess the feasibility and effectiveness of a newly modified protocol-guided single-level laminectomy SDR to treat such pediatric patients. METHODS: A retrospective cohort review was conducted in the CP cases with spastic hemiplegia undergone our newly modified protocol-guided single-level approach SDR since May 2016 to October 2017, and followed by intensive rehabilitation program for at least 12 months in both Shanghai Children's Hospital and Shanghai Rehabilitation and Vocational Training Center for the Disabled. Inclusion and exclusion criteria were set for the selection of patients in the current study. Our study focused on the setup, EMG recording interpretation, and outcome measures for this newly modified rhizotomy scheme. RESULTS: Eleven cases were included in the current study. Based on our new rhizotomy protocol, a total of 34 rootlets over our 11 cases were cut (2 in 4, 3 in 4, 4 in 1, and 5 rootlets in 2 cases, respectively). After SDR and the following rehabilitation program at a mean duration of 19 months, muscle tone of those "target muscles" in affected lower extremities which identified during pre-op assessment decreased by a mean of 1.4 degrees (Modified Ashworth Scale) in our cases. Strength of those target muscles and ROM of joints involved in their lower limbs were reported to have improved significantly as well. All cases showed major progress with regard to their motor function. A mean of about 10-point increase of GMFM-66 score was reported, and five of six cases who were with GMFCS level II preoperatively improved their GMFCS level at the last assessment. Kinematics of joints of hip, knee, and ankle on the affected side in our cases demonstrated a major correction, along with improvement of their foot pressure patterns to the ground during their gait cycles. Surgery-related complications, such as cerebral-spinal fluid leak/infection, long-term hypoesthesia, or urinary/bowel incontinence were not recorded in the current study. CONCLUSION: Single-level SDR when guided by our simplified rhizotomy protocol is feasible and effective to treat pediatric CP cases with spastic hemiplegia.
PURPOSE: It still remains challenging to treat CP cases with spastic hemiplegia using SDR via a single-level approach when guided by the traditional EMG response grading system. Our aim was to assess the feasibility and effectiveness of a newly modified protocol-guided single-level laminectomy SDR to treat such pediatric patients. METHODS: A retrospective cohort review was conducted in the CP cases with spastic hemiplegia undergone our newly modified protocol-guided single-level approach SDR since May 2016 to October 2017, and followed by intensive rehabilitation program for at least 12 months in both Shanghai Children's Hospital and Shanghai Rehabilitation and Vocational Training Center for the Disabled. Inclusion and exclusion criteria were set for the selection of patients in the current study. Our study focused on the setup, EMG recording interpretation, and outcome measures for this newly modified rhizotomy scheme. RESULTS: Eleven cases were included in the current study. Based on our new rhizotomy protocol, a total of 34 rootlets over our 11 cases were cut (2 in 4, 3 in 4, 4 in 1, and 5 rootlets in 2 cases, respectively). After SDR and the following rehabilitation program at a mean duration of 19 months, muscle tone of those "target muscles" in affected lower extremities which identified during pre-op assessment decreased by a mean of 1.4 degrees (Modified Ashworth Scale) in our cases. Strength of those target muscles and ROM of joints involved in their lower limbs were reported to have improved significantly as well. All cases showed major progress with regard to their motor function. A mean of about 10-point increase of GMFM-66 score was reported, and five of six cases who were with GMFCS level II preoperatively improved their GMFCS level at the last assessment. Kinematics of joints of hip, knee, and ankle on the affected side in our cases demonstrated a major correction, along with improvement of their foot pressure patterns to the ground during their gait cycles. Surgery-related complications, such as cerebral-spinal fluid leak/infection, long-term hypoesthesia, or urinary/bowel incontinence were not recorded in the current study. CONCLUSION: Single-level SDR when guided by our simplified rhizotomy protocol is feasible and effective to treat pediatric CP cases with spastic hemiplegia.
Authors: Meghan E Munger; Nanette Aldahondo; Linda E Krach; Tom F Novacheck; Michael H Schwartz Journal: Dev Med Child Neurol Date: 2017-08-08 Impact factor: 5.449
Authors: Marianna Romei; Laura M Oudenhoven; Petra E M van Schie; Willem J R van Ouwerkerk; Marjolein M van der Krogt; Annemieke I Buizer Journal: Gait Posture Date: 2018-06-04 Impact factor: 2.840