Results of selective dorsal rhizotomy in the treatment of local spasticity of lower limb extremities
Keywords:selective dorsal rhizotomy, local spasticity, muscle tone
Aim: To develop diagnostic methods and to improve procedure of the dorsal selective rhizotomy (DSR) in patients with the local spasticity of lower extremities.
Materials and methods: DSR (L2-S1) were performed in 12 patients with incurable local spasticity of lower limbs: 6 cases with infantile cerebral palsy (ICP), 6 cases with consequences of myelitis on the thoracic level and consequences of spinal injury. Muscle tone in different muscles was in range 3,8-4,0 (Ashworth scale), muscle strength – 2,2-2,6 (ASIA scale), range of passive motion was limited to 3-4 level. Degree of motor inability was assessed by Gross Motor Function Classification System (GMFSC). Bupivacaine 1,0% blockage was performed to reveal contractions. Plastic laminotomy was performed in patients with ICP. Catamnesis was 4 years.
Results: Significant decrease of muscle tone was explored in all patients to 1,2-1,6 points (p<0,05), range of motion was elevated (p<0,001), increasing of muscle strength was statistically not reliable. We observed GMFSC motor function improvement in 8 patients (1 category) and decreasing of muscle tone up to 1,5-2,3 points (excellent result), in 2 patients we observed decrease of muscle tone up to 1-1,5 points without any change in locomotive status (good result). In 2 patients muscle tone decreased up to 1 point without any changes according to GMFCS (satisfying result). Recurrence of spasticity, vertebral deformities, sensation disturbances were not revealed.
Conclusions: Lumbar DSR is an effective method of treatment of local incurable spasticity in lower limb extremities. It ensures long-term decrease of muscle tone, increase of functional abilities and improves patients care.
Bupivacaine nerve blockage probe on the pre-op stage reveals irreversible changes in muscles and joints.
DSR is contraindicated in the mixed forms of muscle tone disturbances (rigidity, dystonia) in cases where spasticity was used for the gait.
Plastic laminotomy in children avoids spine column deformity in the long-term period.
DSR has to be performed with the usage of microsurgical instrumentation, microscope and intra-op monitoring.
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