Abstract：
Single-level selective dorsal rhizotomy (SDR), typically indicated for ambulatory patients, is a controversial topic for severe spastic cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level IV or V. The objective of this case series and systematic literature review was to outline the indication and outcome of palliative SDR for nonambulatory patients with CP and GMFCS level IV and V, focusing on improvement of spasticity and of patient and caregiver reported quality of life assessment.
A retrospective case series of patients with CP and GMFCS level IV or V who underwent single-level SDR at the authors\' institution is presented. Furthermore, two databases (PubMed and Embase) were searched and a systematic review with a search string based on the terms \"selective dorsal rhizotomy,\" \"cerebral palsy,\" and \"outcome\" was conducted. The primary outcome was the reduction of spasticity based on the modified Ashworth scale (MAS). Secondary outcomes were change on the Gross Motor Function Measure-66 (GMFM-66), evaluation of patient-reported outcome measures (PROMs), surgical morbidity, and mortality.
Eleven consecutive children under the age of 25 years undergoing palliative single-level SDR were included. All patients showed a reduction in MAS score (mean 1.09 ± 0.66 points) and no surgical morbidity and mortality occurred. For the systematic review results from our case series, in addition to 4 reports, 274 total patients were included. Reduction of spasticity based on MAS score was noted in all studies (mean range 1.09-3.2 points). Furthermore, in 2 studies spasticity of the upper extremities showed a MAS score reduction as well (range 1.7-2.8 points). The GMFM-66 score improved in 72% of the patients, while bladder function improved in 78% of the patients. Based on the PROMs, 92% of the patients/caregivers were satisfied with the outcome and their quality of life after the procedure. Two wound infections (2.7%) and one CSF leak (1.3%) occurred, while no surgery-related deaths were described.
This analysis showed an improvement in spasticity, daily care, and comfort for patients with CP and GMFCS levels IV and V. Larger cohorts analyzing the outcome of palliative single-level SDR, based on the MAS, GMFM-66, and PROMs, are still needed and should be the focus of future studies. Systematic review registration no.: CRD42024495762 (https://www.crd.york.ac.uk/prospero/).
A retrospective case series of patients with CP and GMFCS level IV or V who underwent single-level SDR at the authors\' institution is presented. Furthermore, two databases (PubMed and Embase) were searched and a systematic review with a search string based on the terms \"selective dorsal rhizotomy,\" \"cerebral palsy,\" and \"outcome\" was conducted. The primary outcome was the reduction of spasticity based on the modified Ashworth scale (MAS). Secondary outcomes were change on the Gross Motor Function Measure-66 (GMFM-66), evaluation of patient-reported outcome measures (PROMs), surgical morbidity, and mortality.
Eleven consecutive children under the age of 25 years undergoing palliative single-level SDR were included. All patients showed a reduction in MAS score (mean 1.09 ± 0.66 points) and no surgical morbidity and mortality occurred. For the systematic review results from our case series, in addition to 4 reports, 274 total patients were included. Reduction of spasticity based on MAS score was noted in all studies (mean range 1.09-3.2 points). Furthermore, in 2 studies spasticity of the upper extremities showed a MAS score reduction as well (range 1.7-2.8 points). The GMFM-66 score improved in 72% of the patients, while bladder function improved in 78% of the patients. Based on the PROMs, 92% of the patients/caregivers were satisfied with the outcome and their quality of life after the procedure. Two wound infections (2.7%) and one CSF leak (1.3%) occurred, while no surgery-related deaths were described.
This analysis showed an improvement in spasticity, daily care, and comfort for patients with CP and GMFCS levels IV and V. Larger cohorts analyzing the outcome of palliative single-level SDR, based on the MAS, GMFM-66, and PROMs, are still needed and should be the focus of future studies. Systematic review registration no.: CRD42024495762 (https://www.crd.york.ac.uk/prospero/).
摘要：
目的：单水平选择性背根切断术（SDR），通常适用于非卧床患者，对于患有粗大运动功能分类系统（GMFCS）IV或V级的严重痉挛型脑瘫（CP），是一个有争议的话题。本病例系列和系统文献综述的目的是概述非卧床患者的姑息性SDR的适应症和结果CP和GMFCSIV和V级，重点是改善痉挛状态以及患者和护理人员报告的生活质量评估。
方法：介绍了在作者机构接受单级SDR的CP和GMFCSIV或V级患者的回顾性病例系列。此外，搜索了两个数据库(PubMed和Embase)，并根据术语“选择性背根切断术”进行了系统评价，并使用搜索字符串进行了系统评价，脑瘫,进行了“和”结果“。主要结果是根据改良的Ashworth量表（MAS）减少痉挛。次要结果是粗大运动功能测量值-66（GMFM-66）的变化，评估患者报告的结果测量(PROMs)，手术发病率，和死亡率。
结果：纳入了11名25岁以下连续接受姑息性单一水平SDR的儿童。所有患者的MAS评分均降低（平均1.09±0.66分），未发生手术发病率和死亡率。对于我们案例系列的系统回顾结果，除了4份报告，共包括274名患者。在所有研究中都注意到基于MAS评分的痉挛减少(平均范围1.09-3.2分)。此外，在2项研究中,上肢痉挛也显示MAS评分降低(范围1.7-2.8分).72％的患者GMFM-66评分有所改善，78％的患者膀胱功能得到改善。基于PROM，92％的患者/护理人员对手术后的结果和生活质量感到满意。发生2例伤口感染（2.7%）和1例脑脊液漏（1.3%），虽然没有描述手术相关的死亡。
结论：这项分析表明痉挛有所改善，日常护理,CP和GMFCS水平为IV和V的患者的舒适度。较大的队列分析姑息性单一水平SDR的结果，基于MAS，GMFM-66和PROM,仍然需要，应该是未来研究的重点。系统审查登记号。：CRD42024495762（https：//www。crd.约克。AC.英国/繁荣/）。
方法：介绍了在作者机构接受单级SDR的CP和GMFCSIV或V级患者的回顾性病例系列。此外，搜索了两个数据库(PubMed和Embase)，并根据术语“选择性背根切断术”进行了系统评价，并使用搜索字符串进行了系统评价，脑瘫,进行了“和”结果“。主要结果是根据改良的Ashworth量表（MAS）减少痉挛。次要结果是粗大运动功能测量值-66（GMFM-66）的变化，评估患者报告的结果测量(PROMs)，手术发病率，和死亡率。
结果：纳入了11名25岁以下连续接受姑息性单一水平SDR的儿童。所有患者的MAS评分均降低（平均1.09±0.66分），未发生手术发病率和死亡率。对于我们案例系列的系统回顾结果，除了4份报告，共包括274名患者。在所有研究中都注意到基于MAS评分的痉挛减少(平均范围1.09-3.2分)。此外，在2项研究中,上肢痉挛也显示MAS评分降低(范围1.7-2.8分).72％的患者GMFM-66评分有所改善，78％的患者膀胱功能得到改善。基于PROM，92％的患者/护理人员对手术后的结果和生活质量感到满意。发生2例伤口感染（2.7%）和1例脑脊液漏（1.3%），虽然没有描述手术相关的死亡。
结论：这项分析表明痉挛有所改善，日常护理,CP和GMFCS水平为IV和V的患者的舒适度。较大的队列分析姑息性单一水平SDR的结果，基于MAS，GMFM-66和PROM,仍然需要，应该是未来研究的重点。系统审查登记号。：CRD42024495762（https：//www。crd.约克。AC.英国/繁荣/）。
