Selective dorsal rhizotomy: efficacy and safety in an investigator‐masked randomized clinical trial

@article{McLaughlin1998SelectiveDR,
  title={Selective dorsal rhizotomy: efficacy and safety in an investigator‐masked randomized clinical trial},
  author={John F. McLaughlin and Kristie F Bjornson and Susan J. Astley and Cathy Graubert and Ross M. Hays and Theodore S. Roberts and Robert Price and Nancy Temkin},
  journal={Developmental Medicine \& Child Neurology},
  year={1998},
  volume={40}
}
The objective of this single‐center investigator‐masked randomized clinical trial was to investigate the efficacy and safety of selective dorsal rhizotomy (SDR) in children with spastic diplegia. Forty‐three children with spastic diplegia were randomly assigned on an intention‐to‐treat basis to receive SDR plus physical therapy (PT), or PT alone. Thirty‐eight children completed follow‐up through 24 months. Twenty‐one children received SDR (SDR+PT group) and 17 received PT (PT Only group). SDR… 
Rootless Century
  • W. Landau
  • Medicine, Psychology
    Journal of child neurology
  • 2013
TLDR
It is concluded that SDR is safe and reduces spasticity in children with spastic diplegia and age greater than 10 years might be a contraindication for SDR if the goal is to improve motor skills.
Selective dorsal rhizotomy: meta‐analysis of three randomized controlled trials
TLDR
SDR+PT is efficacious in reducing spasticity in children with spastic diplegia and has a small positive effect on gross motor function.
Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials.
TLDR
SDR+PT is efficacious in reducing spasticity in children with spastic diplegia and has a small positive effect on gross motor function.
Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure.
TLDR
The authors conclude that SPR performed using intraoperative stimulation is valuable in the augmentation of motor function and self-care skills essential to the performance of ADL.
Long-term functional outcome after selective posterior rhizotomy.
TLDR
It is concluded that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function.
Predictors for the benefit of selective dorsal rhizotomy.
Long-term outcomes five years after selective dorsal rhizotomy
TLDR
SDR is a safe and effective method for reducing spasticity permanently without major negative side effects and in a group of carefully selected and systematically followed young children with spastic diplegia it provides lasting functional benefits over a period of at least five years postoperatively.
Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy
TLDR
It is concluded that SDR is a safe procedure, which offers durable and significant functional gains to properly selected children with spasticity related to cerebral palsy.
...
...

References

SHOWING 1-10 OF 68 REFERENCES
Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial
TLDR
In conclusion, SDR combined with PT and OT leads to significantly greater functional motor improvement at 1 year following surgery compared withPT and OT alone.
THE ROLE OF SELECTIVE DORSAL RHIZOTOMY IN cérébral PALSY: CRITICAL EVALUATION OF A PROSPECTIVE CLINICAL SERIES
TLDR
There is often a decrease in lower‐extremity spasticity and functional improvement after SDR with physical therapy, but that there is considerable variability in outcome.
A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy
TLDR
The results indicate that the improvement in motor function after SPR is more than can be explained by the associated intensive physiotherapy.
The electromyographic responses to dorsal rootlet stimulation during partial dorsal rhizotomy are inconsistent.
TLDR
It is suggested that currently used techniques are not reliable for rootlet "selection' and result only in a random partial rhizotomy.
The validity of electrophysiological criteria used in selective functional posterior rhizotomy for treatment of spastic cerebral palsy.
TLDR
It is concluded that contralateral and suprasegmental spread into the upper limbs, neck, and face, and incremental responses are probably valid criteria of abnormality in spasticity.
Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy.
TLDR
Over 90% of children in each phase improved with respect to lower-limb function, and excluding independent walkers and quadriplegics confined to a wheelchair, improvement in the level of ambulation occurred in 87.5%, 71.4%, and 73.7% of patients, in Phases 1, 2, and 3, respectively.
Pain management for children following selective dorsal rhizotomy
TLDR
The use of continuous infusions of morphine and midazolam, along with adjunct ketorolac, to be effective in treating postoperative pain and muscle spasms following SDR is found.
Selective functional posterior rhizotomy for treatment of spastic cerebral palsy in children. Review of 50 consecutive cases.
Fifty consecutive children are described with spastic cerebral palsy treated with selective functional lumbar and sacral rhizotomy and followed for a minimum of 6 months. In all patients, spasticity
A Clinical Report of Long Term Outcomes Following Selective Posterior Rhizotomy
A retrospective clinical follow-up was done of 14 children with cerebral palsy between 14-59 months after selective posterior rhizotomy (SPR). Three children had regressed and two had made minimal,
...
...