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George Georgoulis - One of the best experts on this subject based on the ideXlab platform.
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how i do it selective dorsal rhizotomy using interlaminar approaches for Spastic Diplegia quadriplegia in children with cerebral palsy
Acta Neurochirurgica, 2021Co-Authors: M Sindou, Anthony Joud, George GeorgoulisAbstract:Dorsal rhizotomy is considered the gold standard for treating Spastic Diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of Spasticity. The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access—individually—all L2–S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut. This modality, which requires 5 ± 1 h duration, offers tailored accuracy.
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how i do it selective dorsal rhizotomy using interlaminar approaches for Spastic Diplegia quadriplegia in children with cerebral palsy
Acta Neurochirurgica, 2021Co-Authors: M Sindou, Anthony Joud, George GeorgoulisAbstract:BACKGROUND Dorsal rhizotomy is considered the gold standard for treating Spastic Diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of Spasticity. METHOD The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access-individually-all L2-S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut. CONCLUSION This modality, which requires 5 ± 1 h duration, offers tailored accuracy.
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dorsal rhizotomy for children with Spastic Diplegia of cerebral palsy origin usefulness of intraoperative monitoring
Journal of Neurosurgery, 2018Co-Authors: Andrei Brinzeu, George Georgoulis, M SindouAbstract:OBJECTIVEThe utility of intraoperative neuromonitoring (ION), namely the study of muscle responses to radicular stimulation, remains controversial. The authors performed a prospective study combining ventral root (VR) stimulation for mapping anatomical levels and dorsal root (DR) stimulation as physiological testing of metameric excitability. The purpose was to evaluate to what extent the intraoperative data led to modifications in the initial decisions for surgical sectioning established by the pediatric multidisciplinary team (i.e., preoperative chart), and thus estimate its practical usefulness.METHODSThirteen children with Spastic Diplegia underwent the following surgical protocol. First, a bilateral intradural approach was made to the L2–S2 VRs and DRs at the exit from or entry to their respective dural sheaths, through multilevel interlaminar enlarged openings. Second, stimulation—just above the threshold—of the VR at 2 Hz to establish topography of radicular myotome distribution, and then of the DR...
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keyhole interlaminar dorsal rhizotomy for Spastic Diplegia in cerebral palsy
Acta Neurochirurgica, 2015Co-Authors: M Sindou, George GeorgoulisAbstract:The efficiency and safety of dorsal rhizotomies for cerebral palsy lie in the accuracy of radicular identification together with selectivity of root sectioning. Two different exposures are currently in use. The first is extended laminotomy/laminectomy from the upper lumbar level to the sacrum, which allows accurate identification of all L2–S2 roots/rootlets. The second is limited laminotomy exposing the conus/cauda equina at the thoracolumbar junction; this less invasive method limits accessibility to the roots. To optimize the accuracy and selectivity while minimizing invasiveness, the authors developed a tailored interlaminar procedure targeting the radicular levels involved in the harmful components of Spasticity directly and individually. Six patients with Spastic Diplegia at different levels of the Gross Motor Functional Classification System were selected. In each patient, two to three interlaminar spaces, preselected according to planning, were enlarged in the “keyhole” fashion, respecting the spinous processes and interspinous ligaments. Ventral root stimulation identified the radicular level. Dorsal root stimulation evaluated its implication in the hyperactive segmental circuits, helping quantify the percentage of rootlets to be cut. There were neither wound-related nor general complications. At 1 year of follow-up, X-ray examination did not reveal kyphosis or instability. In all children, the excess of Spasticity was reduced. The Ashworth score decreased from 3.2 on average to 0.6 postoperatively (range: 2–4 to 0–2). Regarding the functional status at 1 year of follow-up for the three ambulatory children, the Gillette ability-to-walk score increased from 3/10 on average to 7.3/10 postoperatively (range: 2–4 to 7–8). For the three non-ambulatory children, abnormal postures, painful contractures and ease of care were much improved. Keyhole interlaminar dorsal rhizotomy (KIDr) offers direct intradural access to each of the ventral/dorsal roots, thus maximizing the reliability of anatomical mapping and allowing individual physiological testing of all targeted roots. The interlaminar approach minimizes invasiveness by respecting the posterior spine structures.
H. K. Graham - One of the best experts on this subject based on the ideXlab platform.
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severe crouch gait in Spastic Diplegia can be prevented a population based study
Journal of Bone and Joint Surgery-british Volume, 2011Co-Authors: Carley Vuillermin, Erich Rutz, Jill Rodda, Benjamin J Shore, K Smith, H. K. GrahamAbstract:We studied the prevalence of severe crouch gait over a 15-year period in a defined population of children with Spastic Diplegia and Gross Motor Function Classification System levels II and III, to determine if there had been a decrease following changes to the management of equinus gait. These changes were replacing observational with three-dimensional gait analysis, replacing single level with multilevel surgery, and replacing gastrocsoleus lengthening with gastrocnemius recession. Of 464 children and adolescents with Spastic Diplegia who underwent three-dimensional gait analysis, 27 had severe crouch gait. Seventeen of these had been managed by isolated lengthening of the gastrocsoleus. Following changes in the management of equinus gait, the prevalence of severe crouch gait decreased from 25% and stabilised at a significantly lower rate, fluctuating between 0% and 4% annually (p We conclude that severe crouch gait in this population was precipitated by isolated lengthening of the gastrocsoleus. These findings may be relevant to other surgical populations, as severe crouch gait may be a useful way to monitor the quality of the surgical management of abnormal gait in children with cerebral palsy and Spastic Diplegia.
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correction of severe crouch gait in patients with Spastic Diplegia with use of multilevel orthopaedic surgery
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Jill Rodda, H. K. Graham, Mary P. Galea, Richard Baker, Gary Nattrass, Rory WolfeAbstract:Background: Severe crouch gait in patients with Spastic Diplegia causes excessive loading of the patellofemoral joint and may result in anterior knee pain, gait deterioration, and progressive loss of function. Multilevel orthopaedic surgery has been used to correct severe crouch gait, but no cohort
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Sagittal gait patterns in Spastic Diplegia
The Journal of bone and joint surgery. British volume, 2004Co-Authors: Jill Rodda, H. K. Graham, L Carson, Mary P. Galea, Rory WolfeAbstract:Classifications of gait patterns in Spastic Diplegia have been either qualitative, based on clinical recognition, or quantitative, based on cluster analysis of kinematic data. Qualitative classifications have been much more widely used but concerns have been raised about the validity of classifications, which are not based on quantitative data. We have carried out a cross-sectional study of 187 children with Spastic Diplegia who attended our gait laboratory and devised a simple classification of sagittal gait patterns based on a combination of pattern recognition and kinematic data. We then studied the evolution of gait patterns in a longitudinal study of 34 children who were followed for more than one year and demonstrated the reliability of our classification. Children with Spastic Diplegia usually walk independently but most have an easily recognised disorder of gait which may include deviations in the sagittal plane such as toewalking, flexed-stiff knees, flexed hips and an anteriorly tilted pelvis with lumbar lordosis. 1 When compared with their peers many also walk at a reduced speed, with increased energy expenditure and impaired functional capability. 2-4 Instrumented gait analysis gives detailed information and quantitative measurements. By a process of clinical interpretation this may help the clinician to understand the gait pattern and perhaps to plan appropriate intervention. 5,6 However, experienced clinicians often describe gait patterns using a combination of clinical examination and clinical observation. In 1986, Rang, Silver and De La Garza 7 described a number of gait patterns in Spastic Diplegia and classified them on a purely observational basis, related to Spasticity or contracture of muscles which work in the sagittal plane. They observed associations between contractures of the psoas and lumbar lordosis, of the adductors and scissoring, of the hamstrings and knee flexion, of rectus femoris and stiff knee gait and of gastrocsoleus and tip-toe gait. By linking these observed patterns to specific shortening of the muscles, the association with management was implied. 7
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ii the management of Spastic Diplegia
Current Orthopaedics, 2003Co-Authors: C E Bache, P Selber, H. K. GrahamAbstract:Abstract A consequence of improved survival of very premature babies is increasing numbers of children presenting to Orthopaedic surgeons with Spastic Diplegia. The majority of these children can walk but gait abnormalities are common and the natural progression is from muscle Spasticity to contracture and eventual bony deformity. This results in increasingly inefficient gait as the child grows and gains weight. Intervention is initially by Spasticity management, enhanced (over recent years) since the advent of Botulinum toxin type A, and later surgical intervention to both contracted muscles and bony deformities. Instrumented gait analysis is a prerequisite of surgery and all deformities should be addressed simultaneously. Surgery should only be considered once the child's function has plateaued, usually between the age of seven and ten. Satisfactory results require patient and carer compliance in what is an intensive rehabilitation involving a multidisciplinary approach.
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femoral derotation osteotomy in Spastic Diplegia proximal or distal
Journal of Bone and Joint Surgery-british Volume, 2003Co-Authors: M Pirpiris, Jill Rodda, A Trivett, Richard Baker, Gary Nattrass, H. K. GrahamAbstract:We describe the results of a prospective study of 28 children with Spastic Diplegia and in-toed gait, who had bilateral femoral derotation osteotomies undertaken at either the proximal intertrochanteric or the distal supracondylar level of the femur. Preoperative clinical evaluation and three-dimensional movement analysis determined any additional soft-tissue surgery. Distal osteotomy was faster with significantly lower blood loss than proximal osteotomy. The children in the distal group achieved independent walking earlier than those in the proximal group (6.9 ± 1.3 v 10.7 ± 1.7 weeks; p
Natasha Clark - One of the best experts on this subject based on the ideXlab platform.
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surgical outcomes of single level bilateral selective dorsal rhizotomy for Spastic Diplegia in 150 consecutive patients
World Neurosurgery, 2019Co-Authors: Samuel M T Jeffery, Balazs Markia, Ian Pople, Kristian Aquilina, Jenny Smith, Amr Z Mohamed, Alison Burchell, Lyn Jenkins, Peter Walsh, Natasha ClarkAbstract:Objectives Selective dorsal rhizotomy (SDR) is used to improve Spasticity, gait, and pain in children with Spastic Diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence, and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single United Kingdom center. Methods Demographics, surgical, postoperative, and follow-up data for all patients undergoing SDR between 2011 and 2016 were collected from medical records. Results Preoperative Gross Motor Function Classification System levels in 150 consecutive patients were II (35%), III (65%), and IV (1%). Median age was 6 years and 58% were male patients. There were no deaths, cerebrospinal fluid leaks, returns to theater, or readmissions within 30 days. There were no new motor or sphincter deficits. Postoperative neuropathic pain was reported by 5.3% and sensory symptoms by 8.7%. Other complications included: postoperative nausea and vomiting (19.3%), superficial wound infection (3.3%), urinary retention (1.3%), headache (6.7%), and urine or chest infection (4.7%). Follow-up data were available for all patients (93% to 12 months, 72% to 24 months). Persistent neuropathic symptoms were reported in 6.5% at 24 months. Conclusions SDR using a single-level approach is a safe procedure with low surgical morbidity. This study complements the growing evidence base in support of SDR for Spastic Diplegia and should help inform decisions when considering treatment options.
Kinanti, Rias Gesang - One of the best experts on this subject based on the ideXlab platform.
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PENGARUH LATIHAN HYDROTHERAPY UNTUK MENINGKATKAN KECEPATAN BERJALAN PADA ANAK CEREBAL PALSY Spastic Diplegia DI YPAC KOTA MALANG
'State University of Malang (UM)', 2019Co-Authors: Hariyati Hariyati, Raharjo Slamet, Kinanti, Rias GesangAbstract:Abstract: The purpose of this research is to find out 1) the effect of hydrotherapy exercise on increasing the running speed in CP Spastic Diplegia students of SMPLB in YPAC Malang, and 2) factors influencing the running speed in CP Spastic Diplegia child. This research uses quantitative qualitative approach, data collection technique through observation, test walk 10meter walk test, and documentation. Results: 1) there is the effect of hydrotherapy exercise to increase the walking speed of Spastic cerebral palsy Diplegia 2) the speed of walking speed of cerebral palsy children can be improved through hydrotherapy exercise. The conclusion of the research results showed that hydrotherapy exercise can improve the speed of walking CP Spastic Diplegia child.Keywords: cerebral palsy Spastic Diplegia, hydrotherapy exercise, walking speedAbstrak: Tujuan penelitian ini untuk mengetahui 1) pengaruh latihan hydrotherapy terhadap peningkatan kecepatan berjalan pada anak CP Spastic Diplegia siswa SMPLB di YPAC Kota Malang, dan 2) faktor-faktor yang mempengaruhi kecepatan berjalan pada anak CP Spastic Diplegia. Penelitian ini menggunakan pendekatan kualitatif kuantitatif, teknik pengumpulan data melalui observasi, tes berjalan 10meter walk test, dan dokumentasi. Hasil penelitian: 1) ada pengaruh latihan hydrotherapy untuk meningkatkan kecepatan berjalan anak cerebral palsy Spastic Diplegia 2) kemampuan kecepatan berjalan anak cerebral palsy dapat ditingkatkan melalui latihan hydrotherapy.Kesimpulan dari hasil penelitian menunjukan bahwa latihan hydrotherapy dapat meningkatkan kecepatan berjalan anak CP Spastic Diplegia.Kata Kunci: cerebal palsy Spastic Diplegia, latihan hydrotherapy, kecepatan berjalan
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PENGARUH HYDROTHERAPY TERHADAP PENINGKATAN GERAK SENDI LUTUT PADA CEREBAL PALSY Spastic Diplegia DI YPAC KOTA MALANG
'State University of Malang (UM)', 2019Co-Authors: Artistiyanto Himawan, Raharjo Slamet, Kinanti, Rias GesangAbstract:This study aims to determine the effect of Hydrotherapy to increasemovement of articulation genu at cerebal palsy Spastic Diplegia. This research usingExperimental with Single Subjek Research method and A-B design. The samplecontain of one children with cerebal palsy spatic Diplegia which the treatment isfloating in the pool with 35-60 minutes in duration and three times every week infrequency through 12 times meeting. The movement of articulation genu will bemeasured after training program has done. The sample analyzation using SSR methodand the instrument that used is Goneometer with stabilization criteria are 15%. Andthe conclusion, there is a significant improvement at the articulation of genu afterhaving a treatment
M Sindou - One of the best experts on this subject based on the ideXlab platform.
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how i do it selective dorsal rhizotomy using interlaminar approaches for Spastic Diplegia quadriplegia in children with cerebral palsy
Acta Neurochirurgica, 2021Co-Authors: M Sindou, Anthony Joud, George GeorgoulisAbstract:Dorsal rhizotomy is considered the gold standard for treating Spastic Diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of Spasticity. The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access—individually—all L2–S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut. This modality, which requires 5 ± 1 h duration, offers tailored accuracy.
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how i do it selective dorsal rhizotomy using interlaminar approaches for Spastic Diplegia quadriplegia in children with cerebral palsy
Acta Neurochirurgica, 2021Co-Authors: M Sindou, Anthony Joud, George GeorgoulisAbstract:BACKGROUND Dorsal rhizotomy is considered the gold standard for treating Spastic Diplegia/quadriplegia in children with cerebral palsy, when rehabilitation programs reveal insufficient to control excess of Spasticity. METHOD The Keyhole Interlaminar Dorsal rhizotomy modality has been developed to access-individually-all L2-S2 roots, intradurally at the corresponding dural sheath, and preserve the posterior spine architecture. Intraoperative neuromonitoring consists of stimulating each ventral root, to verify its myotomal innervation, and dorsal roots, to explore their reflexive muscular responses in order to help determination of the proportion of rootlets to be cut. CONCLUSION This modality, which requires 5 ± 1 h duration, offers tailored accuracy.
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dorsal rhizotomy for children with Spastic Diplegia of cerebral palsy origin usefulness of intraoperative monitoring
Journal of Neurosurgery, 2018Co-Authors: Andrei Brinzeu, George Georgoulis, M SindouAbstract:OBJECTIVEThe utility of intraoperative neuromonitoring (ION), namely the study of muscle responses to radicular stimulation, remains controversial. The authors performed a prospective study combining ventral root (VR) stimulation for mapping anatomical levels and dorsal root (DR) stimulation as physiological testing of metameric excitability. The purpose was to evaluate to what extent the intraoperative data led to modifications in the initial decisions for surgical sectioning established by the pediatric multidisciplinary team (i.e., preoperative chart), and thus estimate its practical usefulness.METHODSThirteen children with Spastic Diplegia underwent the following surgical protocol. First, a bilateral intradural approach was made to the L2–S2 VRs and DRs at the exit from or entry to their respective dural sheaths, through multilevel interlaminar enlarged openings. Second, stimulation—just above the threshold—of the VR at 2 Hz to establish topography of radicular myotome distribution, and then of the DR...
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keyhole interlaminar dorsal rhizotomy for Spastic Diplegia in cerebral palsy
Acta Neurochirurgica, 2015Co-Authors: M Sindou, George GeorgoulisAbstract:The efficiency and safety of dorsal rhizotomies for cerebral palsy lie in the accuracy of radicular identification together with selectivity of root sectioning. Two different exposures are currently in use. The first is extended laminotomy/laminectomy from the upper lumbar level to the sacrum, which allows accurate identification of all L2–S2 roots/rootlets. The second is limited laminotomy exposing the conus/cauda equina at the thoracolumbar junction; this less invasive method limits accessibility to the roots. To optimize the accuracy and selectivity while minimizing invasiveness, the authors developed a tailored interlaminar procedure targeting the radicular levels involved in the harmful components of Spasticity directly and individually. Six patients with Spastic Diplegia at different levels of the Gross Motor Functional Classification System were selected. In each patient, two to three interlaminar spaces, preselected according to planning, were enlarged in the “keyhole” fashion, respecting the spinous processes and interspinous ligaments. Ventral root stimulation identified the radicular level. Dorsal root stimulation evaluated its implication in the hyperactive segmental circuits, helping quantify the percentage of rootlets to be cut. There were neither wound-related nor general complications. At 1 year of follow-up, X-ray examination did not reveal kyphosis or instability. In all children, the excess of Spasticity was reduced. The Ashworth score decreased from 3.2 on average to 0.6 postoperatively (range: 2–4 to 0–2). Regarding the functional status at 1 year of follow-up for the three ambulatory children, the Gillette ability-to-walk score increased from 3/10 on average to 7.3/10 postoperatively (range: 2–4 to 7–8). For the three non-ambulatory children, abnormal postures, painful contractures and ease of care were much improved. Keyhole interlaminar dorsal rhizotomy (KIDr) offers direct intradural access to each of the ventral/dorsal roots, thus maximizing the reliability of anatomical mapping and allowing individual physiological testing of all targeted roots. The interlaminar approach minimizes invasiveness by respecting the posterior spine structures.