Ventral -Dorsal Cervical Rhizotomy for Treatment of Hypertonia in Pediatric Patients

Introduction: Cervical ventral-dorsal rhizotomy (VDR) has shown success in the treatment of medically refractory hypertonia in children who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. Lumbar rhizotomy is commonly performed, however, there are limited data on the treatment of pediatric hypertonia with cervical VDR. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervical VDR for the treatment of hypertonia.

Methods: Retrospective data analysis was performed for children that underwent cervical VDR between 2022-2023. Non-modifiable risk factors, clinical variables, and operative characteristics were collected.

Results: 5 patients (2 female) were included. Four patients underwent a bilateral C6-T1 VDR while one patient underwent a left C7-T1 rhizotomy. Mean age at surgery was 13.4 years, mean operative duration was 231 minutes, mean length of stay was eight days. Three patients had tetraplegic mixed hypertonia, one patient had tetraplegic spasticity, and one patient had diplegic mixed hypertonia. Four patients had a GMFCS of 5 and one patient had a GMFCS of 2. Upper extremity modified Ashworth scale (mAS) measured over 6 muscle groups (total of 30 points) decreased by an average of 6.67 points from 18.7/30 to 12/30. All patients noted functional improvement, mainly in dressing, orthotics fit, and ease when transferring. One patient with existing restrictive lung disease required transient increased BiPAP following surgery which improved prior to discharge. There was no incidence of infection, pneumonia, or wound dehiscence. Long-term functional outcomes are not available yet.

Conclusion : Cervical rhizotomy is safe and effective and should be considered for the treatment of refractory hypertonia. Larger multicenter studies with longer follow-up are necessary to further determine safety along with long-term functional benefits in these patients.