Combined selective dorsal rhizotomy and scoliosis correction procedure in patients with cerebral palsy.
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.
Centre for Spine Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK. samiulm@aol.com.|Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK. samiulm@aol.com.
Samiul
S
Muquit
Centre for Spine Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.|Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Amr
A
Ammar
Centre for Spine Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Luigi
L
Nasto
Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Ahmad A
AA
Moussa
Centre for Spine Studies and Surgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Hossein
H
Mehdian
Department of Neurosurgery, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Michael H
MH
Vloeberghs
D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage; D002547:Cerebral Palsy / Q000601:surgery*; D020878:Device Removal; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D011788:Quality of Life; D019051:Rhizotomy; D012600:Scoliosis / Q000601:surgery*
D009125:Muscle Relaxants, Central; D001418:Baclofen
Baclofen; Cerebral palsy; Scoliosis; Selective dorsal rhizotomy; Spasticity