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European Spine Journal
Published in: European Spine Journal 2/2016

01-02-2016 | Grand Rounds

Combined selective dorsal rhizotomy and scoliosis correction procedure in patients with cerebral palsy

Authors: Samiul Muquit, Amr Ammar, Luigi Nasto, Ahmad A. Moussa, Hossein Mehdian, Michael H. Vloeberghs

Published in: European Spine Journal | Issue 2/2016

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Abstract

https://static-content.springer.com/image/art%3A10.1007%2Fs00586-015-4179-4/MediaObjects/586_2015_4179_Figa_HTML.jpg Intrathecal baclofen (ITB) therapy for spasticity has been suggested to accelerate the development of scoliosis. We present the case of a 17-year-old female patient with cerebral palsy who had ITB therapy from the age of 11 years. During this period, she developed a severe scoliosis measuring 86° from T11 to L4, with pain due to costo-pelvic impingement. Her baclofen pump had reached its end of life and required replacement if ITB therapy was to continue. This coincided with plans for scoliosis corrective surgery.

Methods

We performed scoliosis correction along with removal of baclofen pump and selective dorsal rhizotomy (SDR), as a single combined procedure. SDR was performed instead of ITB pump replacement for management of spasticity.

Results

Following surgery, scoliosis improved to 24°. At 6 month follow-up, there was significant improvement in spasticity and quality of life.

Conclusions

This report illustrates the feasibility of a combined procedure to correct scoliosis and manage spasticity with SDR. We present the case details, our management and review of the published literature regarding the factors influencing treatment of scoliosis and spasticity.
Literature
1.
Burn SC, Zeller R, Drake JM (2009) Do baclofen pumps influence the development of scoliosis in children? J Neurosurg Pediatr 5:195–199CrossRef
2.
Ginsburg GM, Lauder AJ (2007) Progression of scoliosis in patients with spastic quadriplegia after the insertion of an intrathecal baclofen pump. Spine 32:2745–2750PubMedCrossRef
3.
Morrell DS, Pearson JM, Sauser DD (2002) Progressive bone and joint abnormalities of the spine and lower extremities in cerebral palsy. Radiographics 22:257–268PubMedCrossRef
4.
Jones-Quaidoo SM, Yang S, Arlet V (2010) Surgical management of spinal deformities in cerebral palsy. A review. J Neurosurg Spine 13:672–685PubMedCrossRef
5.
Madigan RR, Wallace SL (1981) Scoliosis in the institutionalized cerebral palsy population. Spine 6:583–590PubMedCrossRef
6.
Lonstein JE (2001) Spine deformities due to cerebral palsy. In: Weinstein SL (ed) The pediatric spine: principles and practice. Lippincott Williams & Wilkins, Philadelphia, pp 797–807
7.
Comstock CP, Leach J, Wenger DR (1998) Scoliosis in total body-involvement cerebral palsy. Analysis of surgical treatment and patient and caregiver satisfaction. Spine 23:1412–1424PubMedCrossRef
8.
Broom MJ, Banta JV, Renshaw TS (1989) Spinal fusion augmented by Luque-rod segmental instrumentation for neuromuscular scoliosis. J Bone Joint Surg Am 71:32–44PubMed
9.
Sanders JO, Evert M, Stanley EA et al (1992) Mechanisms of curve progression following sublaminar (Luque) spinal instrumentation. Spine 17:781–789PubMedCrossRef
10.
Sussman MD, Little D, Alley RM et al (1996) Posterior instrumentation and fusion of the thoracolumbar spine for treatment of neuromuscular scoliosis. J Pediatr Orthop 16:304–313PubMedCrossRef
11.
Steinbok P (2001) Outcomes after selective dorsal rhizotomy for spastic cerebral palsy. Childs Nerv Syst 17(1–2):1–18PubMedCrossRef
12.
Dudley RW, Parolin M, Gagnon B et al (2013) Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatr 12(2):142–150PubMedCrossRef
13.
Novak I, McIntyre S, Morgan C et al (2013) A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 55(10):885–910PubMedCrossRef
14.
Kan P, Gooch J, Amini A et al (2008) Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation. Childs Nerv Syst 24(2):239–243PubMedCrossRef
15.
Motta F, Antonello CE (2014) Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. J Neurosur Pediatr 13(3):301–306CrossRef
16.
Buckon CE, Sienko Thomas S, Aiona MD, Piatt JH (1996) Assessment of upper-extremity function in children with spastic diplegia before and after selective dorsal rhizotomy. Dev Med Child Neurol 38(11):967–975PubMedCrossRef
17.
Gigante P, McDowell MM, Bruce SS et al (2013) Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy. J Neurosurg Pediatr 12(6):588–594PubMedCrossRef
18.
Craft S, Park TS, White DA et al (1995) Changes in cognitive performance in children with spastic diplegic cerebral palsy following selective dorsal rhizotomy. Pediatr Neurosurg 23(2):68–74 (discussion 75) PubMedCrossRef
19.
Heetla HW, Staal MJ, Kliphuis C, van Laar T (2009) The incidence and management of tolerance in intrathecal baclofen therapy. Spinal Cord 47(10):751–756PubMedCrossRef
20.
Hefferan MP, Fuchigami T, Marsala M (2006) Development of baclofen tolerance in a rat model of chronic spasticity and rigidity. Neurosci Lett 31(403(1–2)):195–200CrossRef
21.
Park TS, Johnston JM (2006) Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy: technical note. Neurosurg Focus 21(2):1–6
22.
Steinbok P, Tidemann AJ, Miller S, Mortenson P, Bowen-Roberts T (2009) Electrophysiologically guided versus non-electrophysiologically guided selective dorsal rhizotomy for spastic cerebral palsy: a comparison of outcomes. Childs Nerv Syst 25(9):1091–1096PubMedCrossRef
Metadata
Title
Combined selective dorsal rhizotomy and scoliosis correction procedure in patients with cerebral palsy
Authors
Samiul Muquit
Amr Ammar
Luigi Nasto
Ahmad A. Moussa
Hossein Mehdian
Michael H. Vloeberghs
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 2/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-015-4179-4

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