Combined Anterior and Posterior Lumbar Rhizotomy for Treatment of Mixed Dystonia and Spasticity in Children With Cerebral Palsy

• Published in: Neurosurgery Vol. 79; no. 3; pp. 336 - 344
• Main Authors: Abdel Ghany, Walid A., Nada, Mohamed, Mahran, Mahmoud A., Aboud, Ahmed, Mahran, Moustafa G., Nasef, Marwa A.A., Gaber, Mohamed, Sabry, Tamer, Ibrahim, Mohamed H., Taha, Mohamed H.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-09-2016; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc; Neurosurgery
• Subjects: Activities of Daily Living; Adolescent; Cerebral palsy; Cerebral Palsy - complications; Cerebral Palsy - surgery; Child; Dystonia; Dystonic Disorders - etiology; Dystonic Disorders - surgery; Female; Humans; Male; Muscle Spasticity - etiology; Muscle Spasticity - surgery; Neurosurgery; Postoperative Period; Prospective Studies; Range of Motion, Articular - physiology; Research—Human—Clinical Trials; Rhizotomy - methods; Spasticity; Treatment Outcome; Cerebral palsy; Habilitation; Spasticity; Rhizotomy; Dystonia; Mixed hypertonia; Botulinum toxin
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0000000000001271

Abstract
BACKGROUND:
Children with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities.
OBJECTIVE:
To assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP.
METHODS:
Fifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study. Clinical outcome measurements were recorded preoperatively and were evaluated at 2, 6, and 12 months postoperatively. The operative techniques were performed by laminotomy from L1-S1, and intraoperative monitoring was used in all cases. All patients underwent intensive postoperative physiotherapy programs.
RESULTS:
Changes in muscle tone, joint range of motion, and dystonia were significant (P =.000) at postoperative assessment visits.
CONCLUSION:
This study demonstrated the potential of combined anterior and posterior lumbar rhizotomies to improve activities of daily living in children with CP and with mixed spasticity and dystonia.