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| WANG Fengxian,XU Lin,CAO Xu.Selective lumbosacral posterior and anterior rhizotomy for mixed cerebral palsy[J].Chinese Journal of Spine and Spinal Cord,2012,(4):335-338. |
| Selective lumbosacral posterior and anterior rhizotomy for mixed cerebral palsy |
| Received:August 21, 2011 Revised:February 18, 2012 |
| English Keywords:Cerebral palsy Selective posterior rhizotomy Selective anterior rhizotomy Efficacy |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the efficacy of selective posterior rhizotomy(SPR) with selective anterior rhizotomy(SAR) for the treatment of mixed cerebral palsy. Methods: 48 patients with an average age of 8.8 years old（3-22 years） were reviewed retrospectively from January 2004 to January 2010. There were 36 males and 12 females. All cases had mixed cerebral palsy, and all patients presented with spasm compliacted with lower limb athetosis, the muscular tension according to Ashworth spasticity scale was grade 3. Preoperative lower limb dysfunction included: walking independently in 36 cases, walking with assistance in 8 cases and standing with assistance in 4 cases. SPR with SAR was applied in all cases. The L5 and S1 posterior roots in 38 cases and L4, L5 and S1 posterior roots in 10 cases were cut off partly in accordance with the degree of lower limb spasticity by preoperative physical exam. 30-50 percent of the posterior nerve roots were cut off. The L5 anterior roots in 28 cases and S1 anterior roots in 20 cases were cut off partly in accordance with the degree of athetosis. 30 percent of the anterior nerve roots were cut off. Laminae were maintained as far as possible so as not to violate the stability of spine. Results: Postoperative leg or foot numbness were noted in 2 cases, lower limb weakness in 3 cases, low back pain in 2 cases, lower back weakness in 5 cases, urine dysfunction in 1 case, all these were resolved by the corresponding intervention in six months. The average follow-up was 18 months, 48 cases with muscle tension at 1 week, 6 months, 18 months after operation improved significantly compared with preoperation, and the spasm relief rate reached 100%. As for the lower limb athetosis: after 1 week, deterioration was noted in 1 case, which was controlled satisfactively after administration of sedative drugs and baclofen; unchanged in 4, and excellent in 43 cases; after 6 months, unchanged in 5 cases and excellent in 43 cases, no case was noted deterioration; after 18 months, excellent in 44 cases, unchanged in 4，and no deterioration. After 18 months, 5 of 8 cases suffering from immobilization could walk independently, while 3 remained unchanged. 1 of 4 cases suffering standing difficulties could walk independently and 2 could stand up independently, while 1 remained unchanged. Conclusions: SAR and SPR are applicable to mixed cerebral palsy complicated with spasm and lower limb athetosis, which can not only decrease muscle tension, but also control lower limb athetosis to a certain degree. |
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