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Tae Sung Park - One of the best experts on this subject based on the ideXlab platform.

  • Hand somatosensory cortex activity following selective Dorsal Rhizotomy: report of three cases with fMRI.
    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2004
    Co-Authors: Jeffrey G. Ojemann, Tae Sung Park, Robert C. Mckinstry, Pratik Mukherjee, Harold Burton
    Abstract:

    Introduction Selective Dorsal Rhizotomy (SDR) is an effective treatment for lower extremity spasticity in cerebral palsy. Cortical organization in sensory cortex may be abnormal in cerebral palsy, and deafferentation is known to lead to cortical reorganization in many situations.

  • Selective Dorsal Rhizotomy for Spastic Cerebral Palsy
    2004
    Co-Authors: Tae Sung Park, Shi H. Huang
    Abstract:

    Introduction Cerebral palsy (CP) is an important neurological problem, inflicting life-long disabilities on over 500,000 children and adults in the United States alone. Moreover, the prevalence of CP has not declined in recent years despite remarkable advances in neonatal care , and in this nation, approximately 8,600 new patients are diagnosed each year with the disorder . The past decade has seen a remarkable increase in the role of neurosurgeons in care of patients with CP. The newly emerged trend in management of CP was largely due to reintroduction of Dorsal Rhizotomy to neurosurgeons. At this time, a large volume of information is available regarding selective Dorsal Rhizotomy as a therapeutic modality for CP. This chapter attempts to synthesize reported information regarding SDR as well as our own experience with the procedure

  • Quadriceps and hamstring strength changes as a function of selective Dorsal Rhizotomy surgery and rehabilitation.
    Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association, 2001
    Co-Authors: Sandy A. Ross, Jack R. Engsberg, Kenneth S. Olree, Tae Sung Park
    Abstract:

    PurposeObjective measures of strength in children with cerebral palsy (CP) are needed to determine the effect that selective Dorsal Rhizotomy surgery (SDR) and subsequent rehabilitation have on muscle strength. This investigation quantified quadriceps and hamstring strength in children with CP pre-S

  • Lack of specificity in electrophysiological identification of lower sacral roots during selective Dorsal Rhizotomy.
    Journal of neurosurgery, 1997
    Co-Authors: Jeffrey G. Ojemann, Tae Sung Park, Robert M. Komanetsky, Richard A. A. Day, Bruce A. Kaufman
    Abstract:

    The authors investigated the efficacy of anal sphincter electromyography (EMG) in identifying the lower sacral roots during selective Dorsal Rhizotomy. In nine children undergoing selective Dorsal Rhizotomy for cerebral palsy (CP) spasticity, direct electrical stimulation of the L1-S5 Dorsal and ventral roots was performed while monitoring EMG responses from the anal sphincter and lower-extremity muscles. Anal sphincter activation was seen with stimulation of lumbosacral roots at many levels. Stimulation of Dorsal and ventral roots gave anal sphincter EMG responses in 100% of the Dorsal and ventral roots from L-4 and caudally. Only at the L-1 level did a minority of nerve roots have anal sphincter response to stimulation. Patterns of extremity muscle and sphincter activation specific to the S3-5 roots, namely anal sphincter activation without activation of other muscle groups, were found in only five (22%) of 23 roots stimulated. The pattern of stimulation responses in the majority of S3-5 roots indicated that the pathophysiology of lower-extremity spasticity in CP may involve the anal sphincter and does not spare the lower sacral roots. Thus, this study indicates that electrophysiological mapping alone, without anatomical identification, cannot be used to identify the lower sacral roots during selective Dorsal Rhizotomy for CP spasticity, and it proposes a model for investigation of associated bowel and bladder symptoms.

  • Selective Dorsal Rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy
    Journal of neurosurgery, 1997
    Co-Authors: Michael R. Chicoine, Tae Sung Park, Bruce A. Kaufman
    Abstract:

    If the spasticity of cerebral palsy (CP) is reduced in children at a young age by selective Dorsal Rhizotomy, the incidence of lower-extremity deformities requiring orthopedic surgery may be reduced; however, this has never been investigated in detail. The authors examined the effects of selective Dorsal Rhizotomy on rates of lower-extremity orthopedic surgery in 178 children with CP. Age at selective Dorsal Rhizotomy ranged from 2 to 19.3 years (mean 5.5 years) with follow-up intervals ranging from 24 to 70 months (mean 44 months). Spastic CP was classified as quadriplegia (33%), diplegia (65%), and hemiplegia (2%). To assess the effects of early versus late Rhizotomy on rates of orthopedic surgery, patients were grouped as follows: Group I underwent Rhizotomy between 2 and 4 years of age (54 patients), and Group II underwent Rhizotomy between 5 and 19 years of age (124 patients). Comparison of Kaplan-Meier plots of lifetime orthopedic surgery rates revealed that Group II underwent orthopedic surgery at a higher rate than Group I (p = 0.037). Analysis by procedure type revealed higher orthopedic surgery rates in Group II than Group I for heel cord releases (p = 0.0025), adductor releases (p = 0.018), and hamstring releases (p = 0.02). Orthopedic surgery rates were no higher for Group II compared to Group I for ankle/foot operations (p = 0.023), femoral osteotomy (p = 0.25), iliopsoas releases (p = 0.35), and "other" operations (p = 0.013). The data indicate that early Rhizotomy reduces the need for orthopedic surgery for heel cord, hamstring, and adductor releases.

Bruce A. Kaufman - One of the best experts on this subject based on the ideXlab platform.

  • Lack of specificity in electrophysiological identification of lower sacral roots during selective Dorsal Rhizotomy.
    Journal of neurosurgery, 1997
    Co-Authors: Jeffrey G. Ojemann, Tae Sung Park, Robert M. Komanetsky, Richard A. A. Day, Bruce A. Kaufman
    Abstract:

    The authors investigated the efficacy of anal sphincter electromyography (EMG) in identifying the lower sacral roots during selective Dorsal Rhizotomy. In nine children undergoing selective Dorsal Rhizotomy for cerebral palsy (CP) spasticity, direct electrical stimulation of the L1-S5 Dorsal and ventral roots was performed while monitoring EMG responses from the anal sphincter and lower-extremity muscles. Anal sphincter activation was seen with stimulation of lumbosacral roots at many levels. Stimulation of Dorsal and ventral roots gave anal sphincter EMG responses in 100% of the Dorsal and ventral roots from L-4 and caudally. Only at the L-1 level did a minority of nerve roots have anal sphincter response to stimulation. Patterns of extremity muscle and sphincter activation specific to the S3-5 roots, namely anal sphincter activation without activation of other muscle groups, were found in only five (22%) of 23 roots stimulated. The pattern of stimulation responses in the majority of S3-5 roots indicated that the pathophysiology of lower-extremity spasticity in CP may involve the anal sphincter and does not spare the lower sacral roots. Thus, this study indicates that electrophysiological mapping alone, without anatomical identification, cannot be used to identify the lower sacral roots during selective Dorsal Rhizotomy for CP spasticity, and it proposes a model for investigation of associated bowel and bladder symptoms.

  • Selective Dorsal Rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy
    Journal of neurosurgery, 1997
    Co-Authors: Michael R. Chicoine, Tae Sung Park, Bruce A. Kaufman
    Abstract:

    If the spasticity of cerebral palsy (CP) is reduced in children at a young age by selective Dorsal Rhizotomy, the incidence of lower-extremity deformities requiring orthopedic surgery may be reduced; however, this has never been investigated in detail. The authors examined the effects of selective Dorsal Rhizotomy on rates of lower-extremity orthopedic surgery in 178 children with CP. Age at selective Dorsal Rhizotomy ranged from 2 to 19.3 years (mean 5.5 years) with follow-up intervals ranging from 24 to 70 months (mean 44 months). Spastic CP was classified as quadriplegia (33%), diplegia (65%), and hemiplegia (2%). To assess the effects of early versus late Rhizotomy on rates of orthopedic surgery, patients were grouped as follows: Group I underwent Rhizotomy between 2 and 4 years of age (54 patients), and Group II underwent Rhizotomy between 5 and 19 years of age (124 patients). Comparison of Kaplan-Meier plots of lifetime orthopedic surgery rates revealed that Group II underwent orthopedic surgery at a higher rate than Group I (p = 0.037). Analysis by procedure type revealed higher orthopedic surgery rates in Group II than Group I for heel cord releases (p = 0.0025), adductor releases (p = 0.018), and hamstring releases (p = 0.02). Orthopedic surgery rates were no higher for Group II compared to Group I for ankle/foot operations (p = 0.023), femoral osteotomy (p = 0.25), iliopsoas releases (p = 0.35), and "other" operations (p = 0.013). The data indicate that early Rhizotomy reduces the need for orthopedic surgery for heel cord, hamstring, and adductor releases.

  • Predictors of ability to walk after selective Dorsal Rhizotomy in children with cerebral palsy.
    Neurosurgery, 1996
    Co-Authors: Michael R. Chicoine, Tae Sung Park, George P. Vogler, Bruce A. Kaufman
    Abstract:

    SERIAL EVALUATIONS WERE completed after selective Dorsal Rhizotomy on 90 children with spastic cerebral palsy to analyze whether age, the preoperative gait score, voluntary dorsiflexion at the ankle, the diagnosis (quadriplegia or diplegia), or the length of follow-up correlated with the ability to

  • Changes in hip migration after selective Dorsal Rhizotomy for spastic quadriplegia in cerebral palsy
    Journal of neurosurgery, 1995
    Co-Authors: Robert C. Heim, Tae Sung Park, Bruce A. Kaufman, George P. Vogler, Michael J. Noetzel, Madeleine R. Ortman
    Abstract:

    Selective Dorsal Rhizotomy is increasingly used for management of spastic quadriplegic cerebral palsy but rates of hip stability following the operation have not been reported. Determining hip stability by radiographic measurement of lateral migration of the femoral head beyond a lateral edge of the acetabulum after Dorsal Rhizotomy allows an objective assessment of the outcome of the operation. This prospective study examined the effect of selective Dorsal Rhizotomy on lateral migration of the femoral head in 45 children with spastic quadriplegic cerebral palsy. The children ranged in age from 2 to 9 years (average 5 years 1 month) and were grouped according to their ages with 23 children in the 2- to 4-year-old group and 22 children in the 5- to 9-year-old group. Postoperative follow up ranged from 7 to 50 months (average 20 months). The Reimers migration percentage (MP), a measure of the lateral migration of the femoral head, was calculated from anteroposterior hip radiographs taken prior to the operation and at the last follow-up examination. Of the 90 hips involved, 9% improved, 80% remained unchanged, and 11% worsened, yielding a radiographic stability rate of 89%. The hips with postRhizotomy worsening of the MP had an average preoperative MP of 14% (range 9% to 38%) and an average postoperative increase in MP of 18% (range 11% to 37%). Of the 45 children, four subsequently underwent unilateral derotational femoral osteotomies for persistent or worsening hip subluxation. There was a significant tendency for the MP to worsen in patients with lower preRhizotomy MP values (chi 2 = 20.74, df = 4, p = 0.001), but the age of patients and their ambulatory status at the time of Rhizotomy had no bearing on postoperative hip stability. The data indicate that selective Dorsal Rhizotomy prevents progressive lateral migration of the femoral head in the majority of children who undergo the operation for spastic quadriplegia.

  • Effects of selective Dorsal Rhizotomy for spastic diplegia on hip migration in cerebral palsy.
    Pediatric neurosurgery, 1994
    Co-Authors: Tae Sung Park, Bruce A. Kaufman, George P. Vogler, Lawrence H. Phillips, Madeleine R. Ortman, Stephanie M. Mcclure, Patricia E. Gaffney
    Abstract:

    In spastic diplegia of cerebral palsy, migration of the femoral head beyond a lateral edge of the acetabulum is a common orthopedic deformity and requires surgical treatment. We investigated whether selective Dorsal Rhizotomy for spastic diplegia halts or exacerbates lateral hip migration. The Reimers migration percentage computed from preoperative and postoperative hip radiographs was used as an index of the severity of lateral hip migration in all 134 hips of 67 children examined. At the time of Rhizotomy, 38 patients were between 2 and 4 years of age and 29 were between 5 and 11 years of age. The follow-up period ranged from 6 to 10 months in 20 patients and from 15 to 46 months in 47 patients. Overall, the MP remained unchanged in 75% decreased in 17% and increased in 7%; thus, 93% of all hips examined were stable radiographically. Although most patients experienced postoperative hip stability, there was a significant trend for patients with greater preoperative migration to show decreased postoperative migration. The preoperative ambulatory status of patients had no impact on hip stability after Dorsal Rhizotomy. By the last follow-up, only 1 patient had undergone orthopedic operations for a persistent hip deformity. The results suggest that in children with spastic diplegia, selective Dorsal Rhizotomy halts lateral hip migration in the great majority of cases.

Lena Westbom - One of the best experts on this subject based on the ideXlab platform.

Christopher L. Vaughan - One of the best experts on this subject based on the ideXlab platform.

  • level of activity and participation in adults with spastic diplegia 17 26 years after selective Dorsal Rhizotomy
    Journal of Rehabilitation Medicine, 2011
    Co-Authors: Nelleke Gertrude Langerak, Peter P J L Verkoeijen, Graham A Fieggen, Jonathan C. Peter, Jean Hillier, Christopher L. Vaughan
    Abstract:

    textabstractObjective: To evaluate the activity and participation levels of adults with spastic diplegia 17-26 years after selective Dorsal Rhizotomy; to investigate relationships between subjects'functioning and age, socio-economic-status, level of satisfaction and their perceptions of the post-operative outcomes. Design: Observational follow-up study.Patients: Thirty-one subjects with spastic diplegia, age range 21-44 years, who underwent selective Dorsal Rhizotomy between 1981 and 1991. Methods: A semi-structured interview was used to gather data on patients' characteristics and long-term experiences after the operation. The Functional Mobility Scale and Life-Habit questionnaire were completed.Results: Based on the Functional Mobility Scale 84% of subjects were reported as independent for a distance of 5 m, and 61% for 50 and 500 m. Eighty percent were independent in accomplishing all life habits, with most problems found for Mobility and Recreation. This was in agreement with the subjects' perception, with strong correlations between Life-Habit questionnaire accomplishment and satisfaction levels. No significant associations were found between functioning and age at selective Dorsal Rhizotomy, current age and socioeconomic status. Conclusion: More than 15 years after selective Dorsal Rhizotomy, adults with spastic diplegia showed high levels of functioning, and similar levels of satisfaction with life habits. The majority had positive feelings about the neurosurgical procedure, although there is a need for better follow-up after subjects leave school.

  • incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective Dorsal Rhizotomy
    Childs Nervous System, 2009
    Co-Authors: Nelleke Gertrude Langerak, Graham A Fieggen, Edward B Hoffman, Christopher L. Vaughan, Anthony A. Figaji, Jonathan C. Peter
    Abstract:

    Introduction The aim of this study was to evaluate the mechanical status of the spine in patients with spastic diplegia 17–26 years after selective Dorsal Rhizotomy (SDR).

  • selective Dorsal Rhizotomy long term experience from cape town
    Childs Nervous System, 2007
    Co-Authors: Nelleke Gertrude Langerak, Warwick J. Peacock, Graham A Fieggen, Robert P Lamberts, Jonathan C. Peter, Christopher L. Vaughan
    Abstract:

    Introduction Given the large number of cerebral palsy patients who have undergone selective Dorsal Rhizotomy in the past two decades, it is clearly imperative that the clinical community be provided with objective and compelling evidence of the long-term sequelae of the procedure.

  • Selective Dorsal Rhizotomy as a treatment option for children with spastic cerebral palsy.
    Gait & Posture, 1998
    Co-Authors: Christopher L. Vaughan, Nivedita Subramanian, Monica Busse
    Abstract:

    Abstract Cerebral palsy is the most common motor disorder originating in childhood and spasticity is the most frequent manifestation. The treatment strategies to reduce spasticity and thereby ameliorate the attendant gait abnormalities have included physiotherapy, orthoses, antispastic medications, orthopaedic surgery and neurosurgery. Of these, the neurosurgical procedure known as selective Dorsal Rhizotomy has gained widespread exposure, and indeed acceptance, over the past two decades, despite there being some controversy as to its efficacy. In this paper we review: cerebral palsy, including classification and treatment; selective Dorsal Rhizotomy, including historical background, patient selection, operative procedure, clinical outcome and complications; and gait analysis studies, including temporal-distance parameters, joint kinematics, normalisation for growth, and long-term follow-up. Both the short-term (1 year) and long-term (10 years) evidence has demonstrated that selective Dorsal Rhizotomy not only reduces spasticity but it also provides lasting functional benefits as measured by improved range of motion during gait. Rhizotomy is not a panacea for children with spastic diplegia but it is an important treatment option for the clinician to consider.

  • Review article Selective Dorsal Rhizotomy as a treatment option for children with spastic cerebral palsy
    1998
    Co-Authors: Christopher L. Vaughan, Nivedita Subramanian, Monica Busse
    Abstract:

    Cerebral palsy is the most common motor disorder originating in childhood and spasticity is the most frequent manifestation. The treatment strategies to reduce spasticity and thereby ameliorate the attendant gait abnormalities have included physiotherapy, orthoses, antispastic medications, orthopaedic surgery and neurosurgery. Of these, the neurosurgical procedure known as selective Dorsal Rhizotomy has gained widespread exposure, and indeed acceptance, over the past two decades, despite there being some controversy as to its efficacy. In this paper we review: cerebral palsy, including classification and treatment; selective Dorsal Rhizotomy, including historical background, patient selection, operative procedure, clinical outcome and complications; and gait analysis studies, including temporal-distance parameters, joint kinematics, normalisation for growth, and long-term follow-up. Both the short-term (1 year) and long-term (10 years) evidence has demonstrated that selective Dorsal Rhizotomy not only reduces spasticity but it also provides lasting functional benefits as measured by improved range of motion during gait. Rhizotomy is not a panacea for children with spastic diplegia but it is an important treatment option for the clinician to consider. © 1998 Elsevier Science B.V. All rights reserved.

W. Jerry Oakes - One of the best experts on this subject based on the ideXlab platform.

  • Dorsal Rhizotomy for Spasticity
    Nerves and Nerve Injuries, 2015
    Co-Authors: W. Jerry Oakes, Brandon G. Rocque
    Abstract:

    Dorsal Rhizotomy is a neurosurgical procedure used for treatment of spasticity. It is most effective for children with cerebral palsy who are able to ambulate, but who have spasticity that impairs ambulation. Selective Dorsal Rhizotomy is the most widely practiced form of Rhizotomy, and involves stimulation of Dorsal nerve roots and monitoring a response from target muscles. The response of a root to stimulation is used to guide the sectioning of nerve roots that are more likely to be giving rise to pathologic spasticity. However, there is controversy about the effectiveness of nerve root stimulation in identifying pathologic nerve roots. Dorsal Rhizotomy has been shown to significantly decrease spasticity in randomized controlled trials compared to physical therapy alone, but has not been shown to be clearly superior in long-term (> 10 years) follow-up. Potential complications include neurogenic bladder and long-term development of spinal deformity.

  • Scheduled oral analgesics and the need for opiates in children following partial Dorsal Rhizotomy
    Journal of Neurosurgery: Pediatrics, 2007
    Co-Authors: R. Shane Tubbs, Mohammadali Mohajel Shoja, Drew Davis, Leslie Acakpo-satchivi, John C. Wellons, Jeffrey P. Blount, W. Jerry Oakes
    Abstract:

    Object Postoperative epidural morphine is commonly used to control pain in children following Dorsal Rhizotomy for spasticity. The authors report their experience in using a regimen of scheduled minor analgesic drugs to manage postoperative pain, with the goal of avoiding opiate use following a spinal intradural procedure. Methods Postoperative pain scores were analyzed in a group of 22 children who underwent a partial Dorsal Rhizotomy. According to a preestablished standard regimen for postoperative pain control after Dorsal Rhizotomy, in each patient an intraoperative epidural catheter was placed for the potential infusion of postoperative morphine. Additionally, this cohort underwent a scheduled regimen of acetaminophen (10 mg/kg) and ibuprofen (10 mg/kg), alternating every 2 hours. For comparison, a retrospective chart review was performed in 20 patients with rhizotomies completed prior to the use of this oral analgesic protocol. Only one patient received a postoperative dose of morphine epidurally. N...

  • Scheduled oral analgesics and the need for opiates in children following partial Dorsal Rhizotomy.
    Journal of neurosurgery, 2007
    Co-Authors: R. Shane Tubbs, Drew Davis, Leslie Acakpo-satchivi, John C. Wellons, Jeffrey P. Blount, Charles Law, Mohammadali M Shoja, W. Jerry Oakes
    Abstract:

    Postoperative epidural morphine is commonly used to control pain in children following Dorsal Rhizotomy for spasticity. The authors report their experience in using a regimen of scheduled minor analgesic drugs to manage postoperative pain, with the goal of avoiding opiate use following a spinal intradural procedure. Postoperative pain scores were analyzed in a group of 22 children who underwent a partial Dorsal Rhizotomy. According to a preestablished standard regimen for postoperative pain control after Dorsal Rhizotomy, in each patient an intraoperative epidural catheter was placed for the potential infusion of postoperative morphine. Additionally, this cohort underwent a scheduled regimen of acetaminophen (10 mg/kg) and ibuprofen (10 mg/kg), alternating every 2 hours. For comparison, a retrospective chart review was performed in 20 patients with rhizotomies completed prior to the use of this oral analgesic protocol. Only one patient received a postoperative dose of morphine epidurally. None of the remaining patients required postoperative epidural morphine for pain control. Pain scores were significantly lower in this group compared with a retrospective review of patients treated according to the standard regimen. Length of hospital stay was shorter in these patients and antiemetic requirements were lower. A regimen of minor analgesic therapy, when given in alternating doses every 2 hours immediately after partial Dorsal Rhizotomy for spasticity and throughout hospitalization, significantly reduced postoperative pain scores, hospitalization, and antiemetic requirements in these patients.