• Walid A Abdel Ghany, Mohamed Nada, Mahmoud A Mahran, Ahmed Aboud, Moustafa G Mahran, Marwa A A Nasef, Mohamed Gaber, Tamer Sabry, Mohamed H Ibrahim, and Mohamed H Taha.
• Department of *Neurosurgery, ‡Orthopedic Surgery, §Anesthesia and Intensive Care, ¶Physical Medicine and Rehabilitation, and #Neurology, Ain Shams University, Cairo, Egypt; ‖Department of Neurorehabilitation, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; **Ain Shams University, Cairo, Egypt.
• Neurosurgery. 2016 Sep 1; 79 (3): 336-44.

BackgroundChildren with cerebral palsy (CP) can present with severe secondary dystonia with or without associated spasticity of their extremities.ObjectiveTo assess the outcomes of combined anterior and posterior lumbar rhizotomy for the treatment of mixed hypertonia in the lower extremities of children with CP.MethodsFifty children with CP were subjected to combined anterior and posterior lumbar rhizotomies in a prospective study. Clinical outcome measurements were recorded preoperatively and were evaluated at 2, 6, and 12 months postoperatively. The operative techniques were performed by laminotomy from L1-S1, and intraoperative monitoring was used in all cases. All patients underwent intensive postoperative physiotherapy programs.ResultsChanges in muscle tone, joint range of motion, and dystonia were significant (P = .000) at postoperative assessment visits.ConclusionThis study demonstrated the potential of combined anterior and posterior lumbar rhizotomies to improve activities of daily living in children with CP and with mixed spasticity and dystonia.AbbreviationsBAD, Barry-Albright Dystonia ScaleCAPR, combined anterior and posterior lumbar rhizotomyCP, cerebral palsyITB, intrathecal baclofenMAS, modified Ashworth ScaleROM, range of motionSDR, selective dorsal rhizotomy.

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