title: Selective dorsal rhizotomy as an alternative to intrathecal baclofen pump replacement in GMFCS grades 4 and 5 children.
abstract: BACKGROUND
  Conventionally, selective dorsal rhizotomy (SDR) has been reserved for ambulant children and implantation of intrathecal baclofen (ITB) pump for non-ambulant children with cerebral palsy. Rather than replacing the ITB pump in selected Gross Motor Function Classification System (GMFCS) grades 4 and 5 children, we elected to undertake SDR instead. We discuss the rationale and outcomes.
  
  
  OBJECTIVE
  To assess if children with severe spasticity treated with long-term ITB pump would benefit from SDR as alternative procedure to replacement of ITB pump.
  
  
  METHODS
  This study is a prospective review of ten children with severe spasticity. Indications for ITB pump replacement in 3/10 children were previous ITB pump infection and the remaining seven were nearing depletion of drug delivery system. Pre- and post-SDR mean modified Ashworth scores, assessment of urological function and survey of parent/carer satisfaction were undertaken.
  
  
  RESULTS
  Mean Ashworth score reductions post-SDR in the lower limbs and upper limbs were 2.4 and 1.70, respectively. An improvement in urological function was also noticed in 27% of patients. Overall, 90% of parents/carers felt that functional outcome with SDR was improved compared with that of ITB.
  
  
  CONCLUSIONS
  SDR in comparison to ITB in this subgroup is cheaper, less intrusive by avoiding refills/replacement and found to be more effective than ITB in reducing spasticity and providing ease for nursing care. We therefore suggest that consideration should be given to SDR as an alternative in patients previously implanted with ITB systems complicated by infection or nearing end of battery life.
authors.affiliation: Department of Neurosurgery, Queens Medical Centre, Nottingham, UK. drharshalingale@yahoo.com.|Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. drharshalingale@yahoo.com.
authors.forename: Harshal
authors.identifier: http://orcid.org/0000-0001-5391-5325
authors.initials: H
authors.lastname: Ingale
authors.affiliation: Department of Neurosurgery, Queens Medical Centre, Nottingham, UK.|Department of Neurosurgery, Kings College London, London, UK.
authors.forename: Ismail
authors.initials: I
authors.lastname: Ughratdar
authors.affiliation: Department of Neurosurgery, Queens Medical Centre, Nottingham, UK.
authors.forename: Samiul
authors.initials: S
authors.lastname: Muquit
authors.affiliation: Department of Neurosurgery, Queens Medical Centre, Nottingham, UK.|Department of Neurosurgery Faculty of Medicine, Assiut University, Asyut, Egypt.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Moussa
authors.affiliation: Department of Neurosurgery, Queens Medical Centre, Nottingham, UK.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Vloeberghs
mesh_terms: D000293:Adolescent; D001418:Baclofen / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000150:complications / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D060186:Infusions, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009128:Muscle Spasticity; D011446:Prospective Studies; D019051:Rhizotomy / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014549:Urinary Incontinence
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: GMFCS; Intrathecal baclofen; Non-ambulant; Selective dorsal rhizotomy; Spasticity