title: Effect of selective dorsal rhizotomy on daily care and comfort in non-walking children and adolescents with severe spasticity.
abstract: BACKGROUND
  In non-walking children with severe spasticity, daily care can be difficult and many patients suffer from pain. Selective dorsal rhizotomy (SDR) reduces spasticity in the legs, and therefore has the potential to improve daily care and comfort.
  
  
  OBJECTIVE
  To examine effects of SDR on daily care and comfort in non-walking children with severe spasticity due to different underlying neurological conditions.
  
  
  METHODS
  Medical history, changes in daily care and comfort and satisfaction with outcome were assessed retrospectively in non-walking children who underwent SDR in our center, with a mean follow-up of 1y 7m (range 11m-4y 3m). All eligible patients (n = 24, years 2009-2014) were included.
  
  
  RESULTS
  Mean age at SDR was 12y 4m (SD 4y 3m, range 2y 8m-19y 3m). Associated orthopaedic problems were frequent. Seven patients underwent scoliosis correction in the same session. Most improvements were reported in dressing (n = 16), washing (n = 12) and comfort (n = 10). Median score for satisfaction was 7 on a scale of 10 (range 1-9). SDR resulted in reduction of spasticity in leg muscles. In nine patients dystonia was recorded post-operatively, mainly in children with congenital malformations and syndromes.
  
  
  CONCLUSIONS
  SDR is a single event intervention that can improve daily care and comfort in non-walking children with severe spasticity, and can safely be combined with scoliosis correction. Despite the improvements, satisfaction is variable. Careful attention is necessary for risk factors for dystonia, which may be unmasked after SDR.
authors.affiliation: Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: ai.buizer@vumc.nl.
authors.forename: A I
authors.initials: AI
authors.lastname: Buizer
authors.affiliation: Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: P E M
authors.initials: PEM
authors.lastname: van Schie
authors.affiliation: Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: E A M
authors.initials: EAM
authors.lastname: Bolster
authors.affiliation: Department of Neurosurgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: W J
authors.initials: WJ
authors.lastname: van Ouwerkerk
authors.affiliation: Department of Clinical Neurophysiology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: R L
authors.initials: RL
authors.lastname: Strijers
authors.affiliation: Department of Child Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: L A
authors.initials: LA
authors.lastname: van de Pol
authors.affiliation: Department of Orthopaedic Surgery, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Stadhouder
authors.affiliation: Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Becher
authors.affiliation: Department of Neurology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Vermeulen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004421:Dystonia / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000601:surgery*; D019637:Orthopedic Procedures; D005791:Patient Care; D000070659:Patient Comfort; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods; D012600:Scoliosis / Q000601:surgery; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult
keywords: Cerebral palsy; Intervention; Pain; SDR; Scoliosis; Surgery