Authors' objectives:

This review aims to assess the available evidence on the effectiveness of dorsal rhizotomy and intrathecal baclofen for lower extremity spasticity associated with cerebral palsy.

Authors' recommendations: Based on a review of the recent evidence, the ICSI Technology Assessment Committe finds the following: Dorsal rhizotomy remains a safe and effective procedure for reducing lower extremity spasticity when performed on appropriately selected patients at a center with an experienced team that includes specialists in pediatric neurosurgery, orthopedics, neurology, and physiatry. Dorsal rhizotomy is the treatment of choice for children with spastic diplegia, pure spasticity, and good selective motor control. The child should have good underlying stength. A gait lab analysis is an important component of the patients evaluation. Dorsal rhizotomy combined with physical therapy results in better patient outcomes than are achieved with physical therapy alone. Although dorsal rhizotomy is effective in reducing spasticity, there is a role for physical therapy and for orthopedic surgery following dorsal rhizotomy. (Conclusion Grade II) Intrathecal baclofen (with an implantable pump) has the advantages of allowing a trial dose to determine if the baclofen is effective and allowing the adjustment of the treatment dose, if needed. However, studies of intrathecal baclofen have focused on spasticity and range-of-motion measures. There are limited data on functional outcome measures, a lack of long-term follow-up, and higher complications rates (a risk for as long as the pump is implanted) as a result of dosage, pump malfunction, pump migration or rotation, and battery failure. At present, intrathecal baclofen might be considered for patients with dystonia or other conditions that may preclude treatment with dorsal rhizotomy, however, the evidence for baclofen is not as compelling as that for dorsal rhizotomy. Botulinum toxin A (BTA) is an adjunctive but temporary therapy for spasticity. BTA would be suitable for selected patients such as pre-ambulatory children (who may be candidates for dorsal rhizotomy or intrathecal baclofen pump when it is age appropriate) and children who are not candidates for either dorsal rhizotomy or intrathecal baclofen pump. It may also be used to treat persistent spasticity following dorsal rhizotomy.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.icsi.org/index.asp

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Institute for Clinical Systems Improvement

Contact Address: 8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675

Contact Name: icsi.info@icsi.org

Contact Email: icsi.info@icsi.org

Copyright: Institute for Clinical Systems Improvement (ICSI)