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Masrour M, Zare A, Presedo A, Nabian MH. Intrathecal baclofen efficacy for managing motor function and spasticity severity in patients with cerebral palsy: a systematic review and meta-analysis. BMC Neurol 2024; 24:143. [PMID: 38678195 PMCID: PMC11055284 DOI: 10.1186/s12883-024-03647-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Spasticity can significantly affect a patient's quality of life, caregiver satisfaction, and the financial burden on the healthcare system. Baclofen is one of only a few options for treating spasticity. The purpose of this study is to investigate the impact of intrathecal baclofen (ITB) therapy on severe40.23 spasticity and motor function in patients with cerebral palsy. METHODS We conducted a systematic review in PubMed, Scopus, Ovid, and the Cochrane Library in accordance with the PRISMA guidelines. We included studies based on eligibility criteria that included desired participants (cerebral palsy patients with spasticity), interventions (intrathecal baclofen), and outcomes (the Ashworth scales and the Gross Motor Function Measure [GMFM]). The within-group Cohen's d standardized mean differences (SMD) were analyzed using the random effect model. RESULTS We screened 768 papers and included 19 in the severity of spasticity section and 6 in the motor function section. The pre-intervention average spasticity score (SD) was 3.2 (0.78), and the post-intervention average score (SD) was 1.9 (0.72), showing a 40.25% reduction. The SMD for spasticity reduction was - 1.7000 (95% CI [-2.1546; -1.2454], p-value < 0.0001), involving 343 patients with a weighted average age of 15.78 years and a weighted average baclofen dose of 289 µg/day. The SMD for the MAS and Ashworth Scale subgroups were - 1.7845 (95% CI [-2.8704; -0.6986]) and - 1.4837 (95% CI [-1.8585; -1.1088]), respectively. We found no relationship between the participants' mean age, baclofen dose, measurement time, and the results. The pre-intervention average GMFM (SD) was 40.03 (26.01), and the post-intervention average score (SD) was 43.88 (26.18), showing a 9.62% increase. The SMD for motor function using GMFM was 0.1503 (95% CI [0.0784; 0.2223], p-value = 0.0030), involving 117 patients with a weighted average age of 13.63 and a weighted average baclofen dose of 203 µg/day. In 501 ITB implantations, 203 medical complications were reported, including six new-onset seizures (2.96% of medical complications), seven increased seizure frequency (3.45%), 33 infections (16.26%), eight meningitis (3.94%), and 16 cerebrospinal fluid leaks (7.88%). Delivery system complications, including 75 catheter and pump complications, were also reported. CONCLUSION Despite the risk of complications, ITB has a significant impact on the reduction of spasticity. A small but statistically significant improvement in motor function was also noted in a group of patients.
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Affiliation(s)
- Mahdi Masrour
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Zare
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ana Presedo
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France.
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France.
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van de Pol LA, Burgert N, van Schie PEM, Slot KM, Gouw AA, Buizer AI. Surgical treatment options for spasticity in children and adolescents with hereditary spastic paraplegia. Childs Nerv Syst 2024; 40:855-861. [PMID: 37783799 PMCID: PMC10891194 DOI: 10.1007/s00381-023-06159-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To provide an overview of outcome and complications of selective dorsal rhizotomy (SDR) and intrathecal baclofen pump implantation (ITB) for spasticity treatment in children with hereditary spastic paraplegia (HSP). METHODS Retrospective study including children with HSP and SDR or ITB. Gross motor function measure (GMFM-66) scores and level of spasticity were assessed. RESULTS Ten patients were included (most had mutations in ATL1 (n = 4) or SPAST (n = 3) genes). Four walked without and two with walking aids, four were non-walking children. Six patients underwent SDR, three patients ITB, and one both. Mean age at surgery was 8.9 ± 4.5 years with a mean follow-up of 3.4 ± 2.2 years. Five of the SDR patients were walking. Postoperatively spasticity in the legs was reduced in all patients. The change in GMFM-66 score was + 8.0 (0-19.7 min-max). The three ITB patients treated (SPAST (n = 2) and PNPLA6 (n = 1) gene mutation) were children with a progressive disease course. No complications of surgery occurred. CONCLUSIONS SDR is a feasible treatment option in carefully selected children with HSP, especially in walking patients. The majority of patients benefit with respect to gross motor function, complication risk is low. ITB was used in children with severe and progressive disease.
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Affiliation(s)
- Laura A van de Pol
- Department of Child Neurology, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands.
- Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Nina Burgert
- Department of Rehabilitation Medicine, Amsterdam, UMC , Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Petra E M van Schie
- Department of Rehabilitation Medicine, Amsterdam, UMC , Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - K Mariam Slot
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Alida A Gouw
- Department of Neurology & Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam, UMC , Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- Rehabilitation and Development, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Blatt K, Lewis J, Bican R, Leonard J. Selective Dorsal Rhizotomy: Patient Demographics and Postoperative Physical Therapy. Pediatr Neurol 2023; 147:56-62. [PMID: 37556940 DOI: 10.1016/j.pediatrneurol.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/18/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) is a surgical procedure that permanently alters lower extremity spasticity, common in children with spastic cerebral palsy (CP). Intensive postoperative physical therapy (PT) is recommended following SDR. The first purpose of this study is to describe and compare patient demographics between children who received SDR and the population of children with CP at one institution. The second purpose of this study is to compare the completed dose of postoperative PT with the clinically recommended dose for a subset of ambulatory children who underwent SDR. METHODS This retrospective, observational study included 60 children with spastic CP following SDR. A subset (n = 12 ambulatory children) was included to describe the dose of postoperative PT. Information gathered from electronic medical records included age at the time of SDR, sex, Gross Motor Function Classification System level, anatomic distribution, race, county-level habitancy, health insurance provider, timed current procedural terminology codes, and location for postoperative PT encounters within a single institution. RESULTS Black or African American children (P = 0.002), children living in large central metro areas (P = 0.033), and children with public insurance (P ≤ 0.001) were significantly less likely to receive SDR. Children undergoing SDR do not achieve the recommended dose of PT after hospital discharge. CONCLUSION SDR is not equally accessed by patient populations, and postoperative PT frequency is below current recommendations throughout the rehabilitation process. Future studies need to investigate why these disparities exist and what prevents children from meeting the clinically recommended dose of postoperative PT after SDR.
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Affiliation(s)
- Kristen Blatt
- Division of Clinical Therapies, Department of Physical Therapy, Nationwide Children's Hospital, Columbus, Ohio.
| | - Jessica Lewis
- Division of Clinical Therapies, Department of Physical Therapy, Nationwide Children's Hospital, Columbus, Ohio
| | - Rachel Bican
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, Ohio University, Athens, Ohio
| | - Jeffrey Leonard
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
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McEvoy SD, Limbrick DD, Raskin JS. Neurosurgical management of non-spastic movement disorders. Childs Nerv Syst 2023; 39:2887-2898. [PMID: 37522933 PMCID: PMC10613137 DOI: 10.1007/s00381-023-06100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Non-spastic movement disorders in children are common, although true epidemiologic data is difficult to ascertain. Children are more likely than adults to have hyperkinetic movement disorders defined as tics, dystonia, chorea/athetosis, or tremor. These conditions manifest from acquired or heredodegenerative etiologies and often severely limit function despite medical and surgical management paradigms. Neurosurgical management for these conditions is highlighted. METHODS We performed a focused review of the literature by searching PubMed on 16 May 2023 using key terms related to our review. No temporal filter was applied, but only English articles were considered. We searched for the terms (("Pallidotomy"[Mesh]) OR "Rhizotomy"[Mesh]) OR "Deep Brain Stimulation"[Mesh], dystonia, children, adolescent, pediatric, globus pallidus, in combination. All articles were reviewed for inclusion in the final reference list. RESULTS Our search terms returned 37 articles from 2004 to 2023. Articles covering deep brain stimulation were the most common (n = 34) followed by pallidotomy (n = 3); there were no articles on rhizotomy. DISCUSSION Non-spastic movement disorders are common in children and difficult to treat. Most of these patients are referred to neurosurgery for the management of dystonia, with modern neurosurgical management including pallidotomy, rhizotomy, and deep brain stimulation. Historically, pallidotomy has been effective and may still be preferred in subpopulations presenting either in status dystonicus or with high risk for hardware complications. Superiority of DBS over pallidotomy for secondary dystonia has not been determined. Rhizotomy is an underutilized surgical tool and more study characterizing efficacy and risk profile is indicated.
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Affiliation(s)
- Sean D McEvoy
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Brookings, MO, USA
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Brookings, MO, USA
| | - Jeffrey Steven Raskin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
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5
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Lumsden DE. Neurosurgical management of elevated tone in childhood: interventions, indications and uncertainties. Arch Dis Child 2023; 108:703-708. [PMID: 36690424 DOI: 10.1136/archdischild-2020-320907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023]
Abstract
Elevated tone (hypertonia) is a common problem in children with physical disabilities. Medications intended to reduce tone often have limited efficacy, with use further limited by a significant side effect profile. Consequently, there has been growing interest in the application of Neurosurgical Interventions for the Management of Posture and Tone (NIMPTs). Three main procedures are now commonly used: selective dorsal rhizotomy (SDR), intrathecal baclofen (ITB) and deep brain stimulation (DBS). This review compares these interventions, along with discussion on the potential role of lesioning surgery. These interventions variably target spasticity and dystonia, acting at different points in the distributed motor network. SDR, an intervention for reducing spasticity, is most widely used in carefully selected ambulant children with cerebral palsy. ITB is more commonly used for children with more severe disability, typically non-ambulant, and can improve both dystonia and spasticity. DBS is an intervention which may improve dystonia. In children with certain forms of genetic dystonia DBS may dramatically improve dystonia. For other causes of dystonia, and in particular dystonia due to acquired brain injury, improvements following surgery are more modest and variable. These three interventions vary in terms of their side-effect profile and reversibility. There are currently populations of children for who it is unclear which intervention should be considered (SDR vs ITB, or ITB vs DBS). Concerns have been raised as to the equity of access to NIMPTs for children across the UK, and whether the number of surgeries performed each year meets the clinical need.
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Affiliation(s)
- Daniel E Lumsden
- Children's Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Rasadurai A, Frank NA, Greuter LA, Licci M, Weber P, Jünemann S, Guzman R, Soleman J. Patient- and Caregiver-Reported Outcome Measures after Single-Level Selective Dorsal Rhizotomy in Pediatric and Young Adult Patients with Spastic Cerebral Palsy. Pediatr Neurosurg 2023; 58:128-135. [PMID: 37075708 PMCID: PMC10614523 DOI: 10.1159/000530748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The aim of this cohort study was to assess the outcome of single-level selective dorsal rhizotomy (SDR) in children and young adults with spastic cerebral palsy (CP) treated at our institution, focusing on patient-reported outcome measures (PROMs) and quality of life (QoL) of patients and their caregivers. METHODS We included consecutive patients undergoing SDR from 2018 to 2020 at our institution. Subjective outcome was measured through PROMs, while functional outcome was measured through baseline characteristics, operative outcome, as well as short- and long-term follow-up. Furthermore, the effect of age at the time of surgery on patient/caregiver satisfaction was analyzed. RESULTS Seven patients (3 female, 43%) with a median age at surgery of 11.9 years (IQR 8.7-15.5) were included. All patients had a Gross Motor Function Classification (GMFCS) score of at least IV before surgery. Five surgeries were palliative and two non-palliative. Based on PROMs, SDR showed very good QoL and health-related outcome measures for both palliative and non-palliative patients. Patient/caregiver satisfaction was higher for the early subgroup (age ≤11) than the late subgroup (age >11). Functional outcome showed reduced spasticity in both groups. Blood transfusions were never needed, while no cerebrospinal fluid leak, infection, or permanent morbidity was seen. CONCLUSION Based on PROMs, SDR leads to high satisfaction and improved QoL, especially if done at an early age. Further studies with larger cohorts are necessary to underline and confirm our observations.
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Affiliation(s)
- Abeelan Rasadurai
- Faculty of Medicine, University of Basel, Basel, Switzerland,
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland,
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland,
| | - Nicole Alexandra Frank
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Ladina Aurea Greuter
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Maria Licci
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Peter Weber
- Department of Neuropediatrics, University Children's Hospital of Basel (UKBB), Basel, Switzerland
| | - Stephanie Jünemann
- Department of Neuropediatrics, University Children's Hospital of Basel (UKBB), Basel, Switzerland
| | - Raphael Guzman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
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Lee S, Hyun C, KIM K, Kwon HE, Woo M, Koh SE. Effect of Intrathecal Baclofen Pump on Scoliosis in Children With Cerebral Palsy: A Meta-Analysis. Ann Rehabil Med 2023; 47:11-18. [PMID: 36599295 PMCID: PMC10020052 DOI: 10.5535/arm.22108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/17/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To systematically review the effect of intrathecal baclofen pump insertion in children with cerebral palsy (CP) with respect to scoliosis. METHODS A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Google Scholar databases up to June 2022. The inclusion criteria were as follows: (1) studies with a quantitative study design; (2) studies with a study group of children with CP; (3) studies comparing scoliosis in children with and without an intrathecal baclofen pump; and (4) studies with Cobb's angle as a parameter. RESULTS Of the 183 studies found, four studies, all of which were retrospective comparative studies, met the aforementioned inclusion criteria. All studies were homogeneous (I2=0%, p=0.53) and intrathecal baclofen pump insertion accelerated the progression of scoliosis (standard mean difference=0.27; 95% confidence interval=0.07-0.48). CONCLUSION Intrathecal baclofen pumps have been used to alleviate spasticity in children with CP, thus aiding their daily activities and movements. However, their advantages and disadvantages should be reviewed after sufficient time considering the pumps' negative effect on the course of scoliosis.
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Affiliation(s)
- Soolim Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine & Konkuk University Medical Center, Seoul, Korea
| | - Cheolhwan Hyun
- Department of Rehabilitation Medicine, Konkuk University School of Medicine & Konkuk University Medical Center, Seoul, Korea
| | - Kyungmin KIM
- Department of Rehabilitation Medicine, Konkuk University School of Medicine & Konkuk University Medical Center, Seoul, Korea
| | - Hyo Eun Kwon
- Department of Rehabilitation Medicine, Konkuk University School of Medicine & Konkuk University Medical Center, Seoul, Korea
| | - Minwoo Woo
- Department of Rehabilitation Medicine, Konkuk University School of Medicine & Konkuk University Medical Center, Seoul, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine & Konkuk University Medical Center, Seoul, Korea
- Corresponding author: Seong-Eun Koh Department of Rehabilitation Medicine, Konkuk University School of Medicine & Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjingu, Seoul 05030, Korea. Tel: +82-2-2030-5346, Fax: +82-2-2030-5375, E-mail:
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Mansur A, Morgan B, Lavigne A, Phaneuf-Garand N, Diabira J, Yan H, Narayanan UG, Fehlings D, Milo-Manson G, Dalziel B, Breitbart S, Mercier C, Venne D, Marois P, Weil AG, Raskin JS, Thomas SP, Ibrahim GM. Comparison of intrathecal baclofen pump insertion and selective dorsal rhizotomy for nonambulatory children with predominantly spastic cerebral palsy. J Neurosurg Pediatr 2022; 30:217-223. [PMID: 35901772 DOI: 10.3171/2022.4.peds21576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In nonambulatory children with predominantly spastic cerebral palsy (CP), the authors compared care needs, symptom burden, and complications after surgical treatment with either intrathecal baclofen (ITB) pump insertion or selective dorsal rhizotomy (SDR). The patients were treated at two Canadian centers with variability in practice pertaining to these surgical options. METHODS The authors performed a retrospective analysis of nonambulatory children with predominantly spastic quadriplegic or diplegic CP who underwent treatment with ITB or SDR. These two strategies were retrospectively assessed by comparing patient data from the two treatment groups for demographic characteristics, outcomes, and complications. A partial least-squares analysis was performed to identify patient phenotypes associated with outcomes. RESULTS Thirty patients who underwent ITB and 30 patients who underwent SDR were included for analysis. Patients in the ITB group were older and had lower baseline functional status, with greater burdens of spasticity, dystonia, pain, deformity, bladder dysfunction, and epilepsy than patients in the SDR group. In addition, children who underwent SDR had lower Gross Motor Function Classification System (GMFCS) levels and were less likely to experience complications than those who underwent ITB. However, children treated with SDR had fewer improvements in pain than children treated with ITB. A single significant latent variable explaining 88% of the variance in the data was identified. CONCLUSIONS Considerable baseline differences exist within this pediatric CP patient population. Factors specific to individual children must be taken into account when determining whether ITB or SDR is the appropriate treatment.
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Affiliation(s)
- Ann Mansur
- 1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, and
| | - Benjamin Morgan
- 2Department of Medical Imaging, Faculty of Medicine, University of Toronto, Ontario
| | - Alexandre Lavigne
- 3Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec
- 4Brain and Child Development Axis, CHU Sainte-Justine Research Center, Montreal, Quebec
| | - Nicolas Phaneuf-Garand
- 3Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec
- 4Brain and Child Development Axis, CHU Sainte-Justine Research Center, Montreal, Quebec
| | - Jocelyne Diabira
- 3Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec
- 4Brain and Child Development Axis, CHU Sainte-Justine Research Center, Montreal, Quebec
| | - Han Yan
- 1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, and
| | - Unni G Narayanan
- 5Division of Orthopedic Surgery, Hospital for Sick Children, Toronto, Ontario
| | - Darcy Fehlings
- 6Division of Developmental Paediatrics, Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Ontario
| | - Golda Milo-Manson
- 6Division of Developmental Paediatrics, Department of Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Ontario
| | - Blythe Dalziel
- 3Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec
| | - Sara Breitbart
- 7Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claude Mercier
- 3Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec
| | - Dominic Venne
- 3Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec
| | - Pierre Marois
- 4Brain and Child Development Axis, CHU Sainte-Justine Research Center, Montreal, Quebec
| | - Alexander G Weil
- 3Neurosurgery Service, Department of Surgery, Sainte-Justine University Hospital, Montreal, Quebec
| | - Jeffrey S Raskin
- 8Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sruthi P Thomas
- 9Department of Pediatrics and
- 10Department of Physical Medicine and Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - George M Ibrahim
- 1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, and
- 7Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Alayon AL, Hagerty V, Hospedales E, Botros J, Levene T, Samuels S, Spader H. Impact of insurance status, hospital ownership type, and children's hospital designation on outcomes for pediatric neurosurgery patients following spasticity procedures in the USA. Childs Nerv Syst 2021; 37:3881-3889. [PMID: 34467419 DOI: 10.1007/s00381-021-05317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to examine the relationship between insurance status, hospital ownership type, and children's hospital designation with outcomes for pediatric patients undergoing neurosurgical treatment for spasticity. METHODS This retrospective cohort study utilized the Healthcare Cost and Utilization Project Kids' Inpatient Database and included 11,916 pediatric patients (≤ 17 years of age) who underwent neurosurgical treatment for spasticity between 2006 and 2012 using ICD-9-CM procedure codes. RESULTS Uninsured patients had a significantly shorter hospital length of stay compared to Medicaid patients (-1.42 days, P = 0.030) as did privately insured patients (-0.74 days; P = 0.035). Discharge disposition and inpatient mortality rate were not associated with insurance status. There were no significant associations with hospital ownership type. Free-standing children's hospitals retained patients significantly longer compared to non-children's hospitals (+1.48 days; P = 0.012) and had a significantly higher likelihood of favorable discharge disposition (P = 0.004). Mortality rate was not associated with children's hospital designation. CONCLUSION Pediatric patients undergoing neurosurgical treatment for spasticity were more likely to stay in the hospital longer if they were insured by Medicaid or treated in a free-standing children's hospital. In addition, patients in free standing children's hospitals were more likely to be discharged with a favorable disposition.
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Affiliation(s)
- Amaris L Alayon
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Vivian Hagerty
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - Emilio Hospedales
- Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
| | - James Botros
- Department of Neurosurgery, School of Medicine, University of New Mexico, NM, 87131, Albuquerque, USA
| | - Tamar Levene
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Hollywood, FL, 33021, USA
| | - Shenae Samuels
- Office of Human Research, Memorial Healthcare System, 4411 Sheridan St, Hollywood, FL, 33021, USA
| | - Heather Spader
- Department of Neurosurgery, School of Medicine, University of New Mexico, NM, 87131, Albuquerque, USA. .,Division of Pediatric Neuroscience, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Hollywood, FL, 33021, USA.
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10
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Volpon Santos M, Carneiro VM, Oliveira PNBGC, Caldas CAT, Machado HR. Surgical Results of Selective Dorsal Rhizotomy for the Treatment of Spastic Cerebral Palsy. J Pediatr Neurosci 2021; 16:24-29. [PMID: 34316304 PMCID: PMC8276966 DOI: 10.4103/jpn.jpn_26_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/30/2020] [Accepted: 08/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background Selective dorsal rhizotomy (SDR) is one of the surgical alternatives for treating spasticity, especially in children with spastic diplegia secondary to cerebral palsy (CP). It is becoming increasingly used, and the results of this operation need to be further highlighted. Aim The main objective of this article was to present the results of such surgical procedure in a cohort of a specialized center, with a particular focus on a quantitative analysis (goniometry). Materials and Methods Retrospective review of the medical records and gait analyses of a cohort of 34 patients diagnosed with CP submitted to elective SDR at our institution, in a period of 6 years, was carried out. All patients underwent a thorough clinical and neurological assessment, gait analysis at a dedicated laboratory, and magnetic resonance imaging of whole neuro-axis. Statistical Analysis For continuous quantitative variables (goniometric angles and muscle tone), a t-student test was used. A scatterplot regression analysis was used for the comparison of modified Ashworth scale (mAS) scores and goniometry measurements. Results and Conclusion In a mean follow-up of 3.2 years, SDR provides a measurable and consistent improvement in the motor function of spastic patients, as per range of motion and tonus scales, with low complication rates. It also allows for patients to reduce their use of muscle relaxants, even though their global mobility does not change significantly. Therefore, it should be considered for CP patients who suffer with the deleterious effects of spasticity.
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Affiliation(s)
- Marcelo Volpon Santos
- Division of Pediatric Neurosurgery, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Neurorehabilitation, Lucy Montoro Rehabilitation Center, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Vinicius M Carneiro
- Division of Neurosurgery, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Patricia N B G C Oliveira
- Departments of Surgery and Anatomy, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Departments of Neurology and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carla A T Caldas
- Department of Neurorehabilitation, Lucy Montoro Rehabilitation Center, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Departments of Surgery and Anatomy, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Departments of Neurology and Behavioral Sciences, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Helio R Machado
- Division of Pediatric Neurosurgery, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.,Department of Neurorehabilitation, Lucy Montoro Rehabilitation Center, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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