Improved trunk and neck control after selective dorsal rhizotomy in children with spastic cerebral palsy
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LETTER TO THE EDITOR
Improved trunk and neck control after selective dorsal rhizotomy in children with spastic cerebral palsy Chiara Maria Tacchino 1 & Maria Grazia Calevo 2 & Marco Pavanello 3 & Paola Lanteri 4 & Marta Bertamino 1 Received: 1 September 2020 / Accepted: 17 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abbreviations SDR Selective dorsal rhizotomy GMFCS Gross motor function classification system for cerebral palsy LSS Level sitting scale IQR Inter quartile range SD Standard deviation
Dear Editor: We read with great interest the article by Wheelwright M et al. [1] in which the authors presented an interesting systematic review of spinal deformities following selective dorsal rhizotomy (SDR). This work led us to a retrospective analysis of our series of patients undergone to SDR, evaluating the short- and medium-term incidence of scoliosis, as well as the impact on trunk and head control. Randomized clinical trials have established that SDR reduces lower extremity spasticity, increases lower limb range of motion, and improves functional outcome and quality of life in children with spastic cerebral palsy [2, 3]. Suprasegmental effects following SDR, specifically on upper-extremity function, have been also reported [4]. However, there is no data on the effect on the trunk and neck muscle tone, except for a possible long-term risk of spinal deformity, mostly in female children with severe neurologic impairment and/or pre-existing spinal deformity [1].
* Marta Bertamino [email protected] 1
Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
2
Epidemiology, Biostatistics and Committees Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
3
Neurosurgery Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
4
Neurophysiopathology Centre, Fondazione IRCCS, Istituto Neurologico “C. Besta”, Milan, Italy
The present study aims to evaluate the short and medium-term risk of development of scoliosis and to preliminary assess the global improvement in neck and trunk tone after SDR. This is a retrospective review of a prospective database of patients who underwent SDR at Gaslini Children Hospital between March 2016 and December 2019. A minimally invasive approach to SDR has been chosen, with intraoperatory clinic and neurophysiologyguided partial section of the sensory nerve roots. All patients performed pre-surgery spine x-ray, in order to exclude spinal malformations. Trunk and head control was assessed, using level sitting scale (LSS) [4], before surgery (T0) and then at subsequent follow-up (T1–3 months, T2–6 months, T3–12 months). The LSS is an eight-level validated sitting classification index that provides discrete, measurable descriptions of different sitting abilities [5]. Forty-four pediatric patients (28 male, 63.6%) underwent SDR at our center during the period included in the retrospective study. Median age at SDR was 5.3 years (IQR 3.9–6.7 years). Seven were excluded due to insufficient follow-up data; the remaining 37 ch
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