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A preliminary study on the spasticity reduction of quadriceps after selective dorsal rhizotomy in pediatric cases of spastic cerebral palsy

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Abstract

Objective

This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR).

Methods

A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children’s Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2. Muscle tone and motor function were assessed before the operation, at short-term follow-up and at the last follow-up after SDR. Additionally, intraoperative neurophysiological monitoring data were reviewed.

Results

The study comprised 20 eligible cases, where, prior to surgery, 35 quadriceps muscles exhibited spasticity exceeding modified Ashworth Scale grade 2. Following short-term and mid-term follow-up, specifically an average duration of 11 ± 2 days and 1511 ± 210 days after SDR, it was observed that muscle tension in adductors, hamstrings, gastrocnemius, and soleus decreased significantly. This reduction was accompanied by a decrease in quadriceps muscle tone in 24 out of 35 muscles (68.6%). Furthermore, the study found that intraoperative electrophysiological parameters can predict postoperative spasticity relief in the quadriceps. The triggered electromyographic (EMG) output of the transected sensory root/rootlets after single-pulse stimulation revealed that the higher the EMG amplitudes in quadriceps, the greater the likelihood of postoperative decrease in quadriceps muscle tension.

Conclusions

SDR demonstrates the potential to reduce muscle spasticity in lower extremities in children diagnosed with CP, including a notable impact on quadriceps spasticity even they are not targeted in SDR. The utilization of intraoperative neurophysiological monitoring data enhances the predictability of quadriceps spasticity reduction following SDR.

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Data availability

The datasets used and analyzed during this study are available from the corresponding author on reasonable request.

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Funding

Science and Technology Commission of Shanghai Municipality (20Y11905800), Shanghai Children’s Hospital (2020YGZQ05), Shanghai Jiao Tong University (YG2021QN117).

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Authors and Affiliations

  1. Department of Neurosurgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China

    Wenbin Jiang, Li Zhang, Min Wei, Rui Wang, Junlu Wang & Qijia Zhan

  2. Department of Neurosurgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China

    Bo Xiao

Authors
  1. Wenbin Jiang
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  2. Li Zhang
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  3. Min Wei
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  4. Rui Wang
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  5. Bo Xiao
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  6. Junlu Wang
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  7. Qijia Zhan
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Contributions

All authors reviewed and contributed to the manuscript.

Corresponding author

Correspondence to Qijia Zhan.

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Ethical approval

This study was conducted in accordance with the relevant guidelines and the Declaration of Helsinki. It is a retrospective study of clinical, data and it has been approved by the Ethics Review Committee, Shanghai Children’s Hospital, Shanghai Jiao Tong University (Approval No: 2020R069-E02).

Consent to participate

All participants have provided informed consent, indicating their voluntary agreement to participate in the study.

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All authors have granted explicit consent for the publication of their contributions, affirming their informed and voluntary agreement to share their involvement in the study.

Conflict of interest

The authors declare no competing interests.

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Wenbin Jiang and Li Zhang contributed to the work equally and should be regarded as co-first authors.

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Jiang, W., Zhang, L., Wei, M. et al. A preliminary study on the spasticity reduction of quadriceps after selective dorsal rhizotomy in pediatric cases of spastic cerebral palsy. Acta Neurochir 166, 108 (2024). https://doi.org/10.1007/s00701-024-06010-4

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