ORIGINAL

Outcomes of Selective Dorsal Rhizotomy in Non-Walking Children with Spastic Cerebral Palsy

Resultados da Rizotomia Dorsal Seletiva em Crianças Não Deambuladoras com Paralisia Cerebral Espástica

  • Josione Rêgo Ferreira (1)
  • Francisco José Alencar (2)
  • Leonardo Raphael S. Rodrigues (3)
  • Ana Patrícia C. P. Rodrigues (4)
  • Leylane A. M. Rilzer Lopes (5)
  • Clara Linda C. L. Alencar (6)
  • Antonio Luís M. Maia Filho (7)
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Resumo

Introdução: Há opiniões divergentes sobre o uso da rizotomia dorsal seletiva (RDS) para tratamento da espasticidade em crianças que não caminham. Objetivo: Investigar os resultados neurológicos e as complicações peri-operatórias após RDS lombar em crianças não deambuladoras com paralisia cerebral espástica (PC). Métodos: Foram incluídas no estudo 59 crianças não deambuladoras com PC espástica, entre 3 e 9 anos, submetidas a RDS lombar com acesso cirúrgico ao cone medular. Os pacientes foram acompanhados por equipe multidisciplinar e submetidos à reabilitação física intensiva após a cirurgia. Os resultados funcionais foram medidos com 10 meses de pós-cirúrgico, através das escalas de Ashworth modificada e GMFM-88. Resultados: O relaxamento muscular documentado nos membros inferiores pela escala de Ashworth modificada resultou em melhora funcional significativa nas dimensões A e B da escala GMFM-88. Complicações peri-operatórias estiveram presentes em 19 pacientes (32,2%) e consistiram em: retenção urinária (n = 5), cicatrização retardada (n = 2), febre de causa desconhecida (n = 1), dor intensa (n = 11) e disestesias e espasmos (n = 9). Conclusão: A RDS lombar em crianças não deambuladoras com PC espástica promoveu relaxamento muscular nos membros inferiores com melhora significativa da função motora grossa, com complicações peri-operatórias leves e temporárias.

Palavras-chave

Paralisia cerebral; Espasticidade; Rizotomia dorsal seletiva; Monitoramento neurofisiológico intraoperatório; Reabilitação física

Abstract

Introduction: There are divergent opinions on the use of selective dorsal rhizotomy (SDR) to treat spasticity in non-walking children. Objective: to investigate the neurological outcomes and perioperative complications after lumbar SDR in non-walking children with spastic cerebral palsy (CP). Methods: A total of 59 non-walking children with spastic CP, between 3 and 9 year-old, and submitted to lumbar SDR with surgical access to the medullary cone were submitted. The patients were followed-up by a multidisciplinary team and underwent intensive physical rehabilitation after surgery. Functional results were measured using the modified Ashworth and GMFM-88 scales 10 months after surgery. Results: The muscle relaxation documented in the lower limbs by the modified Ashworth scale resulted in significant functional improvement in dimensions A and B of the GMFM-88 scale. Peri-operative complications were present in 19 patients (32.2%), and consisted of urinary retention (n = 5), delayed wound healing (n = 2), fever of unknown cause (n = 1), pain severe (n = 11), and dysesthesias and spasms (n = 9). Conclusions: Lumbar SDR in non-walking children with spastic CP promoted muscle relaxation in the lower limbs with significant improvement in gross motor functions, and mild and temporary perioperative complications.

Keywords

Cerebral palsy; Spasticity; Selective dorsal rhizotomy; Intraoperative neurophysiological monitoring; Physical rehabilitation

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1 MD, Neurologist and PhD student in Health Biotechnology, Integrated Rehabilitation Center – CEIR, State University of Piauí, Teresina, PI, Brazil.
2 MD, MSc. Neurosurgeon and Master in Health Biotechnology, Neurosurgery Department, Children’s Hospital Lucídio Portela, Integrated Rehabilitation Center – CEIR, Biotechnology Center, State
University of Piauí, Teresina, PI, Brazil.
3 PT, MSc. Neurofunctional physical therapist and Master in Health Biotechnology, Integrated Rehabilitation Center – CEIR, Biotechnology Center, State University of Piauí, Teresina, PI, Brazil.
4 PT, Neurofunctional physical therapist, Integrated Rehabilitation Center – CEIR, Teresina, PI, Brazil.
5 OT, Occupational Therapist, Integrated Rehabilitation Center – CEIR, Teresina, PI, Brazil.
6 MD, Pediatric Intensivist, Neurosurgery Department, Children’s Hospital Lucídio Portela, Teresina, PI, Brazil.
7 PhD in Biomedical Engineering, Biotechnology Center, State University of Piauí, Teresina, PI, Brazil.

 

Received Mar 29, 2021
Corrected Apr 5, 2021
Accepted Jan 20, 2022

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