REVIEW
Introducción: La parálisis cerebral (PC) consiste en un grupo de déficits neurológicos permanentes del sistema nervioso. Así, el principal objetivo de la conducción de la PC es mitigar la espasticidad, ya que tiene un alto potencial para generar contracturas, rigidez, luxaciones, dolor y deformidades. Las formas más graves pueden frenarse mediante la rizotomía dorsal selectiva (RDS). Objetivo: El objetivo de este estudio es evaluar los resultados de la RDS y los cambios en la calidad de vida de las personas con PC sometidas a este procedimiento. Metodología: Estudio de revisión sistemática cuya pregunta guía fue elaborada utilizando la estrategia PICO. Fueron seleccionados trabajos completos disponibles en portugués e inglés, con asignación de 10 años. Tras el proceso de selección y elegibilidad, se seleccionaron 9 artículos. Resultados y discusión: En la SDR, la electroneuromiografía se utiliza para evaluar el grado de hiperactividad de las raíces nerviosas de L1 a S2 y la respuesta en la musculatura del segmento correspondiente. Cada radícula se estimula por separado y sólo se seccionan las que presentan actividad espástica. El efecto conseguido es una reducción de la sobreestimulación de los músculos de los miembros inferiores. Los estudios demuestran que la SDR va acompañada de un enriquecimiento de la función motora, una reducción significativa de la espasticidad y un aumento de la amplitud de movimiento. Conclusiones: La SDR es la alternativa más eficaz para el tratamiento de la espasticidad en pacientes con PC con GMFCS nivel II o III debido a la importante mejora en la calidad de vida proporcionada por la reducción de la espasticidad y rigidez y la evolución funcional. Esto reduce la necesidad de nuevas intervenciones quirúrgicas y mejora la independencia en las actividades.
Background: Cerebral palsy (CP) consists of a group of permanent neurological deficits of the nervous system. Thus, the main objective of management of CP is to mitigate spasticity, as it has a high potential to generate contractures, stiffness, dislocations, pain and deformities. More severe forms can be curbed by selective dorsal rhizotomy (SDR). Objective: This study aims to evaluate the SDR outcomes and changes in the quality of life (QoL) of individuals with CP undergoing the procedure. Methods: systematic review study with guiding question elaborated using the PICO strategy. Complete works available in Portuguese and English were selected, assigning 10 years. After the selection and eligibility process, 9 articles were selected. Results and discussion: In SDR, electroneuromyography is used to assess the degree of hyperactivity of nerve roots from L1 to S2 and the response in the musculature of the corresponding segment. Each radicle is stimulated separately and only those with spastic activity are sectioned. The effect achieved is a reduction in the overstimulation of the muscles of the lower limbs. Studies show that SDR is accompanied by an enrichment of motor function, a significant reduction in spasticity and an increase in range of motion. Conclusion: SDR is the most effective alternative for the treatment of spasticity in patients with CP with GMFCS level II or III due to the significant improvement in QoL provided by the reduction of spasticity and stiffness and the functional evolution. This reduces the need for further surgical interventions and improves independence in activities.
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1 Medical student, Faculdade de Ciências Humanas, Exatas e de Saúde do Piauí – FAHESP, Instituto de Educação Superior do Vale do Parnaíba – IESVAP, Parnaíba, PI, Brazil.
2 MD, Food and Nutrition, Intensive Care Unit, University Hospital of Federal University of Piaui, Teresina, PI, Brazil.
3 MD, Neurosurgeon, Santa Casa of Belo Horizonte, Belo Horizonte, MG, Brazil.
Received Apr 14, 2023
Accepted May 9, 2023
