Biomedical subjects

M R Ortman

Publications and source records attributed to M R Ortman.

3 recordsLinked to original sources

PubMed1995

Selective dorsal rhizotomy to decrease spasticity in cerebral palsy.

Until recently, treatment of muscle spasticity in children with cerebral palsy has consisted of physical therapy, bracing, and surgery to release and lengthen tight tendons of contracted muscles and correct muscle contractures. Selective dorsal rhizotomy is a surgical intervention that selectively cuts the spinal sensory nerve rootlets carrying the most abnormal signals, thereby reducing spasticity in all muscle groups of the affected extremities. It is not a cure for spastic cerebral palsy. Children who have this procedure can gain significant increases in knee and thigh ranges of motion and increased strength and muscle control if they have good family support and follow through with intensive postoperative physical therapy.

Cerebral Palsy↗

PubMed1995

Changes in hip migration after selective dorsal rhizotomy for spastic quadriplegia in cerebral palsy.

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.

Cerebral Palsy↗

PubMed1994

Effects of selective dorsal rhizotomy for spastic diplegia on hip migration in cerebral palsy.

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.

Adolescent↗