Preliminary Study To Evaluate The Effectiveness Of A Newly Modified Protocol Guided Selective Dorsal Rhizotomy Via Single Levelapproach To Treat Cerebral Palsy Children With Spastic Hemiplegia Or Monoplegia With Regard To Their Spasticity

Objective To evaluate the effectiveness of a newly modified protocol guided selective dorsal rhizotomy via single level approach to treat cerebral palsy children with spastic hemiplegia & monoplegia with regard to their spasticity.Methods A total of 11 patients with hemiplegia and` monoplegia who underwent SL-SDR surgery in Children’s Hospital of Shanghai from 2015 to now were included in the study.The retrograde statistics were used to compare the muscle strength,muscle tone and joints range of motion(including active joint range of motion and passive joint range of motion)preoperative VS.last follow-up(≥6 months)after surgery to evaluate the effectiveness of the newly modified protocol guided selective dorsal rhizotomy via single level approach.Results In 11 cases,28 muscles were defined as target muscle groups and 15 joints were target joints.Totally,411 nerve posterior rootlets were stimulated in the operation,and 34 of them met the newly modified protocol(33 rootlets were 50% transected,1 rootlet was 75% transected).The muscle tone of the muscle groups in the last follow-up was lower than that in the preoperative(1.0±0.3 vs.2.5±0.5).The difference was statistically significant(P<0.01).After rehabilitation,the muscle strength of the target muscle groups increased compared with preoperative(4.8±0.4vs.4.2±0.4).The difference was statistically significant(P<0.01).Compared with preoperative,the active joints ROM and passive joint ROM of the ankle joints at the last follow-up were increased,and thedifference was statistically significant(P<0.01).Two patients developed lower limbs hypersensitivity within 2 weeks after surgery and relieved after several days.Others had no serious surgical complications.Conclusions The newly modified protocol guided selective dorsal rhizotomy via single level approach alleviate the paralysis of the affected limbs of children with spastic hemiplegia and monoplegia safely and effectively,and increase the mobility of the affected joints,then improve the muscles strength of the affected limbs.However,due to the small number of cases in this study and the short follow-up time,the impact of surgery on the improvement of long-term function needs further research to clarify.