Surgical treatment of spasticity in children: comparison of selective dorsal rhizotomy and intrathecal baclofen pump implantation.
BACKGROUND
Neurosurgical treatments for spasticity in children include the traditional selective dorsal rhizotomy (SDR) and intrathecal baclofen pumps (ITBPs), which have been widely used in the past decade as an attractive alternative. The purpose of the study was to examine and compare the outcomes of these two procedures in the treatment of children with severe spasticity.


METHODS
A consecutive series of 71 children who underwent SDR for treatment of spasticity was compared with a group of 71 children matched by age and preoperative score on the Gross Motor Function Classification System (GMFCS) who underwent ITBP placement. Change in GMFCS score, lower-extremity tone (based on the Modified Ashworth-Bohannon Scale), and lower-extremity passive range of movement (PROM) at 1 year as well as the need for subsequent orthopedic procedures and parents' satisfaction were selected as outcome measures.


RESULTS
At 1 year, both SDR and ITBP decreased tone, increased PROM, and improved function. Both procedures resulted in a high degree of patient satisfaction. Compared with ITBP, SDR provided a larger magnitude of improvement in tone (-2.52 vs -1.23, p < 0.0001), PROM (-0.77 vs -0.39, p = 0.0138), and gross motor function (-0.66 vs -0.08, p < 0.0001). In addition, fewer patients in the SDR group required subsequent orthopedic procedures (19.1 vs 40.8%, p = 0.0106).


CONCLUSIONS
For children with moderate to severe spasticity, SDR and ITBP are both effective surgical treatments. Our results indicate SDR is more effective in reducing the degree of spasticity and improving function than ITBP is in this group of patients.
Kan
Peter
P
Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
Gooch
Judith
J
Amini
Aminullah
A
Ploeger
Diana
D
Grams
Barbara
B
Oberg
Wende
W
Simonsen
Sara
S
Walker
Marion
M
Kestle
John
J
D001418:Baclofen / Q000008:administration & dosage*; D002675:Child, Preschool; D006801:Humans; D015918:Infusion Pumps, Implantable; D007278:Injections, Spinal; D009048:Motor Skills / Q000187:drug effects / Q000502:physiology; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000601:surgery*; D019635:Neurosurgical Procedures; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000187:drug effects / Q000502:physiology; D019051:Rhizotomy; D016896:Treatment Outcome