Cervicothoracic Ventral-Dorsal Rhizotomy for Treatment of Brachial Hypertonia in Cerebral Palsy

Author:

Abdelmageed Sunny1,Dalmage Mahalia2,Mossner James M.1,Trierweiler Robin3,Krater Tim4,Raskin Jeffrey S.5

Affiliation:

1. Northwestern University Feinberg School of Medicine

2. University of Chicago Pritzker School of Medicine

3. NuVasive (United States)

4. Shirley Ryan Ability Lab

5. Ann and Robert H. Lurie Children’s Hospital

Abstract

Abstract Purpose Cervicothoracic ventral-dorsal rhizotomy (VDR) is a potential treatment of medically refractory hypertonia in children who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervicothoracic VDR for the treatment of hypertonia. Methods Retrospective data analysis was performed for children that underwent non-selective cervicothoracic VDR between 2022–2023. Non-modifiable risk factors, clinical variables, and operative characteristics were collected. Results 6 patients (3 female) were included. Four patients underwent a bilateral C6-T1 VDR, one patient underwent a left C7-T1 VDR, and another underwent a left C6-T1 VDR. Three patients had quadriplegic mixed hypertonia, one patient had quadriplegic spasticity, one patient had triplegic mixed hypertonia, and one patient had mixed hemiplegic hypertonia. The mean difference of proximal upper extremity modified Ashworth scale (mAS) was − 1.4 ± 0.55 (p = 0.002), and − 2.2 ± 0.45 (p < 0.001) for the distal upper extremity. Both patients with independence noted quality of life improvements as well as increased ease with dressing and orthotics fits. Caregivers for the remaining four patients noted improvements in caregiving provision, mainly in dressing, orthotics fit, and ease when transferring. Conclusion Cervicothoracic VDR is safe, provides tone control and quality of life improvements in short-term follow-up. It can be considered for the treatment of refractory hypertonia. Larger multicenter studies with longer follow-up are necessary to further determine safety along with long-term functional benefits in these patients.

Publisher

Research Square Platform LLC

Reference33 articles.

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3. The epidemiology of the primary dystonias in the north of England;Duffey PO;Adv Neurol,1998

4. Baclofen in the treatment of dystonia;Greene P;Clin Neuropharmacol,1992

5. Development of resistance to botulinum toxin type A in patients with torticollis;Greene P;Mov Disord,1994

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