Role of Dorsal Rhizotomy in the Comprehensive Management of Childhood Spasticity.

Abstract

Spasticity, characterized by muscle hypertonia, in children poses long-term challenges, leading to motor dysfunction, joint contractures, and a decline in overall quality of life (QOL). This underscores the critical need for effective spasticity management in disabled children. Various interventions, including oral medications, neurorehabilitation, and surgical procedures, have been used in the management of childhood spasticity. Dorsal rhizotomy, a neurosurgical intervention, plays a vital role in this context, selectively and functionally severing roots/rootlets to manage spasticity. Treatment modalities for spasticity encompass basic and active management, with interventions like dorsal rhizotomy, intrathecal baclofen infusion (ITB), and local injection of botulinum toxin (BTX). A strategic approach involves a "spasticity first" policy, prioritizing spasticity reduction, followed by active management and functional improvement through neurorehabilitation and orthopedic surgery. Comparative assessment of treatments, considering factors like age and joint involvement, guides the selection of interventions. Dorsal rhizotomy stands out for its sustainable and cost-effective reduction of spasticity, offering broad applicability across severity levels and diverse pathologies. Despite its efficacy, dorsal rhizotomy has limitations, including its invasiveness, irreversible nature, and the need for postoperative lifelong neurorehabilitation. Careful patient selection by a multidisciplinary spasticity clinic is crucial. The procedure's distinctive role, effectiveness, and cost-effectiveness place dorsal rhizotomy as a valuable tool in comprehensive childhood spasticity management.