Stacey D Miller, Emma Lewis, Jonathan Lau, Maria Juricic, Vuong Nguyen, Paul Steinbok, Firoz Miyanji, Kishore Mulpuri
{"title":"选择性背根切断术治疗脑瘫儿童脊柱侧凸的效果:一项长期随访研究。","authors":"Stacey D Miller, Emma Lewis, Jonathan Lau, Maria Juricic, Vuong Nguyen, Paul Steinbok, Firoz Miyanji, Kishore Mulpuri","doi":"10.1097/BPO.0000000000002878","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Selective dorsal rhizotomy (SDR) is commonly used to reduce spasticity in children with cerebral palsy (CP). Children with CP have an increased risk of spinal deformities that increase with age and Gross Motor Function Classification System (GMFCS) level. Few studies have considered the risk of spinal deformity post-SDR by GMFCS level. The purpose of this review was to evaluate the incidence and severity of spinal deformities in children with CP, overall and by GMFCS level, a minimum of 5 years after SDR.</p><p><strong>Methods: </strong>In this retrospective review, participants included all those who had an SDR before January 1, 2013, at a Canadian pediatric hospital. Participants had to have a spine radiograph preoperatively and a minimum 5 years post-SDR. Age, GMFCS level, level of laminectomy, percentage of rootlets cut, and orthopaedic surgical history were collected. Scoliosis was evaluated using coronal curve and was measured pre-SDR and a minimum 5 years post-SDR or until spine surgery. When available, sagittal plane radiographs were reviewed.</p><p><strong>Results: </strong>A total of 107 participants (61 male, 46 female), at GMFCS levels I to V (2,25,22,45, and 13, respectively) were included. The mean age at SDR was 4.8 years (SD 1.5), with a mean follow-up of 12.7 years (SD 4.9). Post-SDR, 57 (53%) participants had scoliosis, with the major curve averaging 46 degrees (SD 34.9). Scoliosis measuring >10 degrees was found in 8 (32%) participants at level II, 4 (18%) at level III, 33 (73%) at level IV and 12 (92%) at level V. No participants at GMFCS levels I to III, and 35% and 67% of those at levels IV and V, respectively, had a curve magnitude >40 degrees. Of those who had lateral imaging, 38% had excessive kyphosis, 21% hyperlordosis, and 16% spondylolisthesis.</p><p><strong>Conclusions: </strong>The rate of scoliosis is consistent with the natural history of children with CP without surgical intervention as reported in the literature when compared by GMFCS level and curve severity.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"158-163"},"PeriodicalIF":1.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789574/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children With Cerebral Palsy: A Long-term Follow-up Study.\",\"authors\":\"Stacey D Miller, Emma Lewis, Jonathan Lau, Maria Juricic, Vuong Nguyen, Paul Steinbok, Firoz Miyanji, Kishore Mulpuri\",\"doi\":\"10.1097/BPO.0000000000002878\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Selective dorsal rhizotomy (SDR) is commonly used to reduce spasticity in children with cerebral palsy (CP). Children with CP have an increased risk of spinal deformities that increase with age and Gross Motor Function Classification System (GMFCS) level. Few studies have considered the risk of spinal deformity post-SDR by GMFCS level. The purpose of this review was to evaluate the incidence and severity of spinal deformities in children with CP, overall and by GMFCS level, a minimum of 5 years after SDR.</p><p><strong>Methods: </strong>In this retrospective review, participants included all those who had an SDR before January 1, 2013, at a Canadian pediatric hospital. Participants had to have a spine radiograph preoperatively and a minimum 5 years post-SDR. Age, GMFCS level, level of laminectomy, percentage of rootlets cut, and orthopaedic surgical history were collected. Scoliosis was evaluated using coronal curve and was measured pre-SDR and a minimum 5 years post-SDR or until spine surgery. When available, sagittal plane radiographs were reviewed.</p><p><strong>Results: </strong>A total of 107 participants (61 male, 46 female), at GMFCS levels I to V (2,25,22,45, and 13, respectively) were included. The mean age at SDR was 4.8 years (SD 1.5), with a mean follow-up of 12.7 years (SD 4.9). Post-SDR, 57 (53%) participants had scoliosis, with the major curve averaging 46 degrees (SD 34.9). Scoliosis measuring >10 degrees was found in 8 (32%) participants at level II, 4 (18%) at level III, 33 (73%) at level IV and 12 (92%) at level V. No participants at GMFCS levels I to III, and 35% and 67% of those at levels IV and V, respectively, had a curve magnitude >40 degrees. 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引用次数: 0
摘要
背景:选择性背侧神经根切断术(SDR)通常用于减轻脑瘫(CP)患儿的痉挛。CP患儿脊柱畸形的风险随着年龄和大运动功能分类系统(GMFCS)水平的增加而增加。很少有研究通过GMFCS水平考虑sdr后脊柱畸形的风险。本综述的目的是评估CP患儿脊柱畸形的发生率和严重程度,总体和GMFCS水平,SDR后至少5年。方法:在这项回顾性研究中,参与者包括2013年1月1日之前在加拿大儿科医院所有患有SDR的患者。参与者必须在术前和sdr后至少5年进行脊柱x线摄影。收集患者年龄、GMFCS水平、椎板切除术程度、椎根切除率和骨科手术史。使用冠状曲线评估脊柱侧凸,并在sdr前和sdr后至少5年或脊柱手术前测量。如有可能,复查矢状面x线片。结果:共纳入107名受试者(男性61名,女性46名),GMFCS水平为I至V(分别为2、25、22、45和13)。SDR时的平均年龄为4.8岁(SD 1.5),平均随访时间为12.7年(SD 4.9)。sdr后,57名(53%)参与者出现脊柱侧凸,主弯平均为46度(SD 34.9)。II级8人(32%),III级4人(18%),IV级33人(73%),V级12人(92%)。GMFCS I - III级无受试者,IV级和V级分别有35%和67%的受试者出现> - 40度的脊柱侧凸。在接受侧位成像的患者中,38%的患者有过度后凸,21%的患者有前凸过大,16%的患者有脊柱滑脱。结论:在GMFCS水平和脊柱弯曲严重程度方面,脊柱侧凸发生率与文献报道的未手术治疗CP患儿的自然病史一致。证据等级:四级。
The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children With Cerebral Palsy: A Long-term Follow-up Study.
Background: Selective dorsal rhizotomy (SDR) is commonly used to reduce spasticity in children with cerebral palsy (CP). Children with CP have an increased risk of spinal deformities that increase with age and Gross Motor Function Classification System (GMFCS) level. Few studies have considered the risk of spinal deformity post-SDR by GMFCS level. The purpose of this review was to evaluate the incidence and severity of spinal deformities in children with CP, overall and by GMFCS level, a minimum of 5 years after SDR.
Methods: In this retrospective review, participants included all those who had an SDR before January 1, 2013, at a Canadian pediatric hospital. Participants had to have a spine radiograph preoperatively and a minimum 5 years post-SDR. Age, GMFCS level, level of laminectomy, percentage of rootlets cut, and orthopaedic surgical history were collected. Scoliosis was evaluated using coronal curve and was measured pre-SDR and a minimum 5 years post-SDR or until spine surgery. When available, sagittal plane radiographs were reviewed.
Results: A total of 107 participants (61 male, 46 female), at GMFCS levels I to V (2,25,22,45, and 13, respectively) were included. The mean age at SDR was 4.8 years (SD 1.5), with a mean follow-up of 12.7 years (SD 4.9). Post-SDR, 57 (53%) participants had scoliosis, with the major curve averaging 46 degrees (SD 34.9). Scoliosis measuring >10 degrees was found in 8 (32%) participants at level II, 4 (18%) at level III, 33 (73%) at level IV and 12 (92%) at level V. No participants at GMFCS levels I to III, and 35% and 67% of those at levels IV and V, respectively, had a curve magnitude >40 degrees. Of those who had lateral imaging, 38% had excessive kyphosis, 21% hyperlordosis, and 16% spondylolisthesis.
Conclusions: The rate of scoliosis is consistent with the natural history of children with CP without surgical intervention as reported in the literature when compared by GMFCS level and curve severity.
期刊介绍:
Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.