title: Combined Anterior and Posterior Lumbar Rhizotomy for Treatment of Mixed Dystonia and Spasticity in Children With Cerebral Palsy.
abstract: Children with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities.
  
  
  
  To assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP.
  
  
  
  Fifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study. Clinical outcome measurements were recorded preoperatively and were evaluated at 2, 6, and 12 months postoperatively. The operative techniques were performed by laminotomy from L1-S1, and intraoperative monitoring was used in all cases. All patients underwent intensive postoperative physiotherapy programs.
  
  
  
  Changes in muscle tone, joint range of motion, and dystonia were significant (P = .000) at postoperative assessment visits.
  
  
  
  This study demonstrated the potential of combined anterior and posterior lumbar rhizotomies to improve activities of daily living in children with CP and with mixed spasticity and dystonia.
  
  
  
  BAD, Barry-Albright Dystonia ScaleCAPR, combined anterior and posterior lumbar rhizotomyCP, cerebral palsyITB, intrathecal baclofenMAS, modified Ashworth ScaleROM, range of motionSDR, selective dorsal rhizotomy.
authors.affiliation: Department of *Neurosurgery, ‡Orthopedic Surgery, §Anesthesia and Intensive Care, ¶Physical Medicine and Rehabilitation, and #Neurology, Ain Shams University, Cairo, Egypt; ‖Department of Neurorehabilitation, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; **Ain Shams University, Cairo, Egypt.
authors.forename: Walid A
authors.initials: WA
authors.lastname: Abdel Ghany
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nada
authors.forename: Mahmoud A
authors.initials: MA
authors.lastname: Mahran
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aboud
authors.forename: Moustafa G
authors.initials: MG
authors.lastname: Mahran
authors.forename: Marwa A A
authors.initials: MA
authors.lastname: Nasef
authors.forename: Mohamed
authors.initials: M
authors.lastname: Gaber
authors.forename: Tamer
authors.initials: T
authors.lastname: Sabry
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Ibrahim
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Taha
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D002547:Cerebral Palsy / Q000150:complications / Q000601:surgery*; D002648:Child; D020821:Dystonic Disorders / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D019051:Rhizotomy / Q000379:methods*; D016896:Treatment Outcome