Cervical Selective Dorsal Rhizotomy in the Treatment of Cerebral Palsy
Živný, B., Severa, S.
(Praha, Nové Město na Moravě)
We have performed 161 Selective Dorsal Rhizotomies (SDR) in the treatment of 136 patients between 1.5 and 49 years (132 kids) with spastic or mixed forms of Cereberal Palsy (CP) since July 3rd 2003. We have starterd our experience with the well recognized SDR in the (thoraco)lumbosacral (SDR-(T)LS) level with excellent results; the first SDR in the cervical (cervicothoracal) (SDR-C(T)) level we have performed September 23rd 2004.
We analyse results of the first 33 SDR-C(T)s based on preoperative reflex evaluation in patients between 3 and 49 years (32 kids), in 6 patients was unilateral procedure done, in 25 patients was SDR in both levels (SDR-(T)LS and SDR-C(T)) performed. We have evaluated the functional results 3 to 31 months postoperatively.
There are no any complications related to SDR-C(T). Functional improvement was found in all patients post SDR-C(T): The most seen effects are dramatic reduction of upprer extremities and some reduction of lower extremities spasticity, rigidity and contractures, dramatic improvement in gross and some in fine motor skills of the upper extremities, reduction of generalized dystonic attacs, reduction of orofacial spasticity, improvement of breathing functions due to breathing muscles spasticity relieve, reduction of hypersalivation and improvement of communicational and cognitive skills
SDR-C(T) is safe and very efficient procedure significantly enhancing the therapeutic possibilities in the treatment of hemi-, tri- or tetra-paretic and mixed-form CP patients with broad spectrum of severity of their disability. Optimal SDR-C(T) candidates are the chidlren with spastic hemiplegia. In spastic tri- or tetra-plegia may be combination of SDR-C(T) and SDR-(T)LS very efficient and effect of both procedures is more then simply additive.
V Praze dne 15.4.2007
MUDr. Boris Živný
Stamicova 21, 162 00 Praha 6