FSPR Surgery First Choice for Spastic Cerebral Palsy
Cerebral palsy is a non-progressive brain injury caused by various causes from before birth to one month after birth, manifesting as central motor dysfunction and postural abnormalities, mostly accompanied by varying degrees of mental retardation, epilepsy, psychological and behavioral abnormalities, speech disorders, swallowing difficulties, visual, hearing and sensory impairments, and learning difficulties.
The prevalence of cerebral palsy in newborns is 0.18%-0.4%, and the latest statistics have reached 0.59%. Cerebral palsy has a great impact on the child’s family and society, and poverty due to cerebral palsy has become a social problem.
Cerebral palsy treatment should also be based on principles
In the process of clinical consultation, we found that many cerebral palsy patients or their families are very blind in choosing the treatment. Due to the desire to seek medical treatment urgently, they often waste a lot of energy and financial resources, and more unfortunately, they miss the best time for treatment.
There are many types of cerebral palsy, nearly 8% of which become spastic cerebral palsy. There are different treatments for children with cerebral palsy at different stages of development, and for children with spastic cerebral palsy, surgical treatment is available. There are many ways to surgically treat cerebral palsy, and it is especially important to choose the best time and procedure. Many patients choose the orthopedic rehabilitation method, which can cause the deformity to recur and the spasticity to remain within a very short time after surgery.
At present, we adopt intraoperative electrophysiological monitoring technology in the clinic and choose the treatment pathway of release of limb spasticity → rehabilitation → orthopedic → re-rehabilitation, which is consistent with the foreign model of treating cerebral palsy, ensuring the surgical effect, reducing the risk of surgery, improving the surgical efficacy, also avoiding the recurrence of spasticity, improving the motor function, improving the quality of life and working ability of patients, and enabling them to return to society.
What is FSPR surgery?
In recent years, due to the advancement of basic medicine, the update of equipment, the application of multi-conductor electrophysiological recorders, and the introduction of treatment protocols combining multiple procedures, SPR (selective posterior spinal nerve root dissection) has come a long way, rising from the anatomical level to the functional level, which is FSPR, or functional selective posterior spinal nerve root dissection.
FSPR is performed by intraoperative monitoring through multi-conductor electrophysiological techniques to determine the proportion of posterior spinal nerve roots to be resected, making the extent and proportion of sensory nerves to be resected more scientific and objective. The patient’s muscle tone is adjusted comprehensively so that the muscle tone of spastic muscles is as close to normal as possible. The muscle spasm in cerebral palsy patients is not limited to a single muscle, but often manifests as spasm of multiple muscles or muscle groups, and this surgery can achieve comprehensive adjustment of muscle tone, and can provide long-term, stable and complete solution to the pain of muscle spasm in patients, providing the prerequisite for maximum recovery of their motor functions.
It is worth mentioning that FSPR only selectively blocks part of the posterior nerve root fibers, without affecting the anterior nerve roots that govern muscle movement and motor function. The exact site of surgery can depend on the patient’s specific condition: surgery in the lumbar spine to address lower extremity spasticity and surgery in the cervical spine to address upper extremity spasticity.
Before each surgery, we will establish a set of scientific and reasonable individualized treatment plan, including preoperative evaluation and selection of appropriate methods, etc. We will also insist on long-term formal rehabilitation training after FSPR to ensure the effectiveness of rehabilitation.
Selectivity” and “functionality” in FSPR
Since there are various types of cerebral palsy, not all of them require surgery. The relationship between FSPR and orthopedic surgery should be corrected. FSPR cannot completely replace orthopedic surgery, but it should be noted that FSPR surgery to relieve spasticity should be performed first, and then orthopedic surgery should be performed later. In addition, we applied bone anchor nails to carry out tendon transposition, lengthening and fixation in the second stage of cerebral palsy surgery, which improved the accuracy and success rate of cerebral palsy orthopaedic surgery.
Selective posterior spinal nerve root dissection (FSPR) has three meanings: one is to select the appropriate case, the other is to select the nerve distribution segment to release the spasm, and the third is to selectively cut the small bundle of posterior roots with low threshold for electrical stimulation. These three should be one without the other, and anyone who blindly expands cases without regard to quality is not in line with this principle. “Functional” means that the nerve function should be preserved as much as possible to prevent numbness, intractable pain, sensory abnormalities and bladder function.
What kind of cases are suitable for FSPR surgery?
FSPR surgery is currently the first choice for the treatment of spastic cerebral palsy at home and abroad, and the effect is most direct and significant, but FSPR surgery is only effective in these cases.
1, spastic cerebral palsy;
2. Mixed cerebral palsy with spasticity (stiffness) as the main cause;
3. Hand and upper limb spasticity (stiffness);
4.The best treatment effect is during the age of 2.5-6 weeks;
5. Normal or near normal intelligence, able to cooperate with post-operative rehabilitation training;
6, the trunk and limbs have certain motor functions, only due to contracture caused by abnormal gait and dynamic deformity;
7.Severe spasticity or even ankylosis of the lower extremities, which makes perineal care very difficult;
8.Spastic palsy (commonly known as “hard palsy”): spastic palsy of limbs left after traumatic brain injury, meningitis, stroke and brain tumor surgery; spastic palsy of limbs left after cervical and lumbar spine surgery; spastic palsy of limbs left after spinal cord tumor surgery and spinal cord injury; hereditary (familial) spastic paraplegia.