| Selective posterior rhizotomy(SPR),mainly for the treatment of cerebral palsy(CP)with spasmodic,was initiated by Xu Lin in the Asia-Pacific region in the 1990 s.In the early stages of the treatment,He proposed two new corollaries of the SPR spasmolysis mechanism: the theory of the big loop and the one of combining the large and small loops.In the progress of operational development of 20 years,due to the exact curative effect of surgery,the surgery is subject to the medical profession as a whole wide range of reception.However,this procedure partially removed the lamina,it inevitably affectd the integrity of the posterior column structure of the spine.Therefore,whether postoperative multi-laminectomy causes postoperative spinal instability has became a hot topic in mainstream academic circles.Domestic Yi Bin performed short-term follow-up.The results showed that the surgical procedure of restrictive laminectomy had no significant effect on the stability of the spine in the short term,but no relevant reports on the follow-up in the mid and long-term have been mentioned.Therefore,this study was conducted for this purpose.Objective To observe the effects of postoperative lumbosacral SPR for children with spastic cerebral palsy and long-term stability of the lunbar spine.Methods According to their age,22 children with spastic cerebral palsy who were included in the standard were divided into group A(3~7 years old,including 7 years old)11 cases and group B(over 7 years old)11 cases.The lumbar vertebrae positive side,left-right oblique position and dynamic position plain film were taken in 22 children before operation,half a year after operation and at the last follow-up after operation.Then we would measure changes in coronal Cobb angle,lateral lumbar Cobb angle,sacral slope,apical distance,lumbar lordosis index and the Posner index before and after surgery and at the final follow-up.At the same time,the Area Statistics Method was used to measure postoperative laminar regeneration and the life questionnaire survey was conducted.All collected measurements would take statistics to perform in-group and inter-group comparisons.Results(1)All patients in group A and group B were followed up for postoperative.Group A had an average interval of 9.27 years from the first stage of admission to the last follow-up,while Group B had an average interval of 9.54 years from the first stage of admission to the last follow-up.(2)At the last follow-up,7 of 22 cases(31.8%)had occasional lumbar pain,3 cases(13.6%)had occasionally hip pain,2 cases(9.0%)had occasional knee pain and 1 case(4.5%)occurred knee pain more than once a year.(3)There was no significant difference in the indexes between the preoperative and postoperative follow-up of group A.In group B,there was no significant difference between preoperative and final follow-up except the Coronal Cobb Angle and sacral slope.(4)There was no significant difference in the evaluation of the lumbar instability of the Posner A and B groups before and after the surgery.(5)Only comparative laminectomy defect rates were significantly different betweem group A and B.The average rate of lamina defect in group B was higher than that in group A.The other groups had no significant differences between the comparative index.(6)Although there were 2 cases of L5,S1 spina bifida and 10 cases of mild scoliosis(Cobb angle 1°~9°)before operation in group A,there was no significant increase in Cobb angle after operation.In group B,6 cases had mild scoliosis(Cobb angle 1° ~5°)before operation and 10 cases had mild scoliosis(Cobb angle 1°~8°)after the last follow-up.(7)There was no lumbar spondylolisthesis or lumbar spondylolysis in both groups.Conclusion The selective spinal rhizotomy in the lumbosacral segment had no significant influence on the stability of the lumbar spine in the mid to long-term and the operation could reduce the muscle tension and relieve the spasm.Moreover,the younger children got operated,the better effective improvement in the lamina regeneration. |
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