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Selective dorsal rhizotomy: Analysis of two rootlet sectioning techniques

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dc.contributor.author Mantese, Beatriz
dc.contributor.author Pirozzi Chiusa, Christian
dc.contributor.author Basilotta Marquez, Yamila
dc.contributor.author Gotter Campo, María Pía
dc.contributor.author Nazar, Ricardo
dc.contributor.author Crespo, Marcos José
dc.contributor.author Toledo, Alfredo
dc.contributor.author Ravera, Emiliano Pablo
dc.date.accessioned 2024-02-08T13:36:57Z
dc.date.available 2024-02-08T13:36:57Z
dc.date.issued 2023-12-13
dc.identifier.citation Mantese B, Pirozzi Chiusa CG, Basilotta Marquez Y, Gotter Campo MP, Nazar R, Crespo M, Toledo A, Ravera E. Selective dorsal rhizotomy: Analysis of two rootlet sectioning techniques. Childs Nerv Syst. 2023 Dec 13. doi: 10.1007/s00381-023-06247-x es_ES
dc.identifier.uri https://doi.org/10.1007/s00381-023-06247-x
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/979
dc.description.abstract Objective: To analyze and compare the efficacy of two selective dorsal rhizotomy (SDR) techniques with intraoperative neurophysiological monitoring, using instrumented three-dimensional gait analysis. Introduction: SDR is a common, irreversible surgical treatment increasingly used to address gait disturbances in children with chronic non-progressive encephalopathy by reducing spasticity. Various techniques have been used, which mainly differ in the percentage of rootlets selected for sectioning. A greater proportion of rootlets sectioned leads to a more effective reduction of spasticity; however, there is a potential risk of unwanted neurological effects resulting from excessive deafferentation. While there is evidence of the short- and long-term benefits and complications of SDR, no studies have compared the effectiveness of each technique regarding gait function and preservation of the force-generating capacity of the muscles. Materials and methods: Instrumented three-dimensional gait analysis was used to evaluate two groups of patients with spastic cerebral palsy treated by the same neurosurgeon in different time periods, initially using a classic technique (cutting 50% of the nerve rootlets) and subsequently a conservative technique (cutting no more than 33% the nerve rootlets). Results: In addition to an increase in knee joint range of motion (ROM), in children who underwent SDR with the conservative technique, a statistically significant increase (p = 0.04) in the net joint power developed by the ankle was observed. Patients who underwent SDR with the conservative technique developed a maximum net ankle joint power of 1.37 ± 0.61 (unit: W/BW), whereas those who were operated with the classic technique developed a maximum net ankle joint power of 0.98 ± 0.18 (unit: W/BW). The conservative group not only showed greater improvement in net ankle joint power but also demonstrated more significant enhancements in minimum knee flexion during the stance phase and knee extension at initial contact. Conclusion: Our results show that both techniques led to a reduction in spasticity with a positive impact on the gait pattern. In addition, patients treated with the conservative technique were able to develop greater net ankle joint power, leading to a better scenario for rehabilitation and subsequent gait. es_ES
dc.language.iso eng es_ES
dc.publisher Springer es_ES
dc.subject Parálisis Cerebral es_ES
dc.subject Cerebral Palsy es_ES
dc.subject Análisis de la Marcha es_ES
dc.subject Gait Analysis es_ES
dc.subject Rizotomía es_ES
dc.subject Rhizotomy es_ES
dc.subject Espasticidad Muscular es_ES
dc.subject Muscle Spasticity es_ES
dc.title Selective dorsal rhizotomy: Analysis of two rootlet sectioning techniques es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.description.fil Fil: Mantese, Beatriz. Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Fil: Gotter Campo, María Pía. Fleni. Servicio de Neuroortopedia; Argentina.
dc.description.fil Fil: Nazar, Ricardo. Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Fil: Crespo, Marcos José. Fleni. Centro de Rehabilitación Adultos CR. Laboratorio de Marcha y Análisis de Movimiento; Argentina.
dc.description.fil Fil: Mantese, Beatriz. Hospital de Pediatría Juan P. Garrahan. Departamento de Neurocirugía Pediátrica; Argentina. Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Fil: Gotter Campo, María Pía. Fleni. Servicio de Neuroortopedia; Argentina.
dc.description.fil Fil: Nazar, Ricardo. Fleni. Departamento de Neurocirugía; Argentina.
dc.description.fil Crespo, Marcos José. Fleni. Centro de Rehabilitación Adultos CR. Laboratorio de Marcha y Análisis de Movimiento; Argentina. Fleni. Centro de Rehabilitación Infantil CRI-CETNA. Clínica de Tecnología Asistiva; Argentina.
dc.relation.ispartofCOUNTRY Alemania
dc.relation.ispartofCITY Berlín
dc.relation.ispartofTITLE Child's nervous system
dc.relation.ispartofTITLE Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery.
dc.relation.ispartofISSN 1433-0350
dc.relation.ispartofISSN 1433-0350
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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