Efficacy Observation Of Selective Dorsal Rhizotomy In The Treatment Of Muscle Spasticity Of Lower Limbs

Objective To observe the clinical efficacy of selective dorsal rhizotomy(SDR)in the treatment of muscle spasticity of lower limbs.Methods Retrospectively analysis the data of 101 patients with muscle spasticity of lower limbs who received selective dorsal rhizotomy in Shanghai neuro-medical center of Qingdao University since June 2016 to June 2019.Fifty-five patients who were followed up for at least 6 months met the study inclusion criteria,including 40 males(72.7%)and 15 females(27.3%).The age range during surgery was 5～62 years,and the median of age was 21 years old,the interquartile of age is 25 years.The course of disease distribution during operation is 4～51 years,and the median is 16 years,the interquartile range is 11 years.The most manifestations are including abnormal movement and posture(for instance,scissor step,crouching gait,etc.),increased muscle tension in the lower limbs,hyperflexion of the knee tendons,and deformities of the limbs(hip flexion,knee flexion,varus or eversion,pointed feet),etc.There are 31 spastic cerebral palsy(56.4%),including 26 spastic diplegia(47.3%),4 spastic quadriplegia(7.3%),1 spastic hemiplegia(1.8%),and in the patients with cerebral palsy gross motor function grading system: 1 in grade Ⅰ(3.2%),14 in grade Ⅱ(45.2%),10 in grade Ⅲ(32.3%),and 6 grade Ⅳ(19.4%).There are 24 patients(43.6%)with simple muscle spasticity of lower limbs who is pure hereditary spastic paraplegia.With the guidance of the comprehensive evaluation and the formulation of a systemic plan of Multiple Disciplines Team(MDT),the patients that met the inclusion criteria and received SDR+ Physical Therapy(PT)combined with multi-modal techniques treatment such as single-level laminectomy,intraoperative Electromyography monitoring,micro-neurosurgical technique,were evaluated with Manual Muscle Test(MMT),Modified Ashworth Scale(MAS),spastic angle(R2-R1)of Modified Tardieu Scale and Berg balance score at first month,third month and sixth month postoperative that compared with preoperative.Results The Friedman rank sum test was used to compare the differences between thematched-pairs design of groups,and the Bonferroni test was used to correct the level P<0.05/6=0.0083 to reject the null hypothesis.Differences between each group-targeted muscle’Manual Muscle Test and modified Ashworth Scale,spasticity angle(R2-R1)of the modified Tardieu scale and Berg balance scale before and at 1 month,3 months,and 6 months after surgery all were statistically significant(P<0.0001).Paired comparison analysis indicated that preoperative Manual Muscle Test,modified Ashworth Scale,spasticity angle(R2-R1)of the modified Tardieu scale,and Berg balance scale were matched with the matched groups at 1 month,3 months,and 6 months after surgery,respectively.The differences were statistically significant(P<0.0001).The differences between the matched groups of Manual Muscle Test and modified Ashworth Scale at 1 and6 months postoperative were also statistically significant(P<0.0001).The results show that the surgical method that adheres to physical therapy post-operative continuously not only does lead to an increase in muscle strength,but also decreases muscle tone,and the sixth months is still improved compared to the first month after surgery.At the same time,the joint spasm angle postoperative was significantly improved compared with before operation,which improved the range of motion of patient’s joint and the ability to balance activities.Most patients experience numbness postoperative in the lower limbs,which is related to the partial dorsal rhizotomy of the spinal nerve(i.e.the sensory roots),and relieved significantly with about 1～2 months after operation.After approach 3～4 weeks of physical therapy,muscle strength recovered to the level of pre-operative gradually.There were no severe complications such as CNS infection,cerebrospinal fluid leakage,incontinence,spondylolisthesis or spinal deformity,but only transient muscle weakness and numbness of lower limbs.Conclusion Selective dorsal rhizotomy with the guidance of MDT is an effective surgical intervention method for patients with muscle spasticity of lower limbs,which is combined with single-level laminectomy,intraoperative electromyography monitoring and micro-neurosurgery techniques.And the multi-modal techniques are with the advantages of precision and minimally invasive.Meanwhile," Enhanced Recovery After Surgery" treatment also take hospital stay shorter and hospitalization cost less.This solution is a safe and effective treatment for patients with muscle spasticity of lower limbs.It creates opportunities or lays a good foundation for long-term rehabilitation.