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Comparing short‐term outcomes between conus medullaris and cauda equina surgical techniques of selective dorsal rhizotomy
Author(s) -
Duffy Elizabeth A,
Hornung Alexander L,
Chen Brian PoJung,
Munger Meghan E,
Aldahondo Nanette,
Krach Linda E,
Novacheck Tom F,
Schwartz Michael H
Publication year - 2021
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14716
Subject(s) - conus medullaris , rhizotomy , cauda equina , medicine , sagittal plane , spasticity , gait , ankle , physical medicine and rehabilitation , anatomy , spinal cord , dorsum , psychiatry
Aim To compare short‐term outcomes between conus medullaris (conus) and cauda equina (cauda) selective dorsal rhizotomy (SDR) techniques in children with spastic cerebral palsy. Method This was a retrospective review of SDR at a single center from 2013 to 2017. Gait and functional outcome measures were assessed at no more than 18 months pre‐SDR (baseline) and 8 to 36 months post‐SDR (follow‐up). Transient complications during inpatient stay were quantified. Results In total, 21 and 59 children underwent conus and cauda SDR respectively. Ashworth Scale scores were nearly normalized at follow‐up. Most physical examination and functional measures exhibited similar baseline to follow‐up responses for both groups. From baseline to follow‐up, sagittal plane knee kinematics for both groups significantly improved ( p <0.01) by 11° at initial contact, 9° to 10° in stance phase, and 4° in swing phase. Sagittal plane ankle kinematics improved more for the cauda group than the conus group in both stance phase (10° vs 2°, p <0.01) and swing phase (13° vs 3°, p <0.01). Post‐surgical complications were similar between groups. Interpretation Conus and cauda SDR techniques resulted in similar short‐term outcomes except in ankle kinematics at follow‐up. The cauda group exhibited a large improvement towards dorsiflexion, while there was residual equinus in the conus group despite Ashworth Scale scores normalizing equally in both groups. What this paper adds Conus and cauda selective dorsal rhizotomy (SDR) resulted in mostly similar short‐term gait and functional outcomes. Conus SDR resulted in residual equinus dynamically, despite normalized spasticity measures. Post‐surgical complications were mostly similar between SDR techniques.