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The investigators will investigate the selective dorsal rhizotomy in post traumatic brain and spinal cord injury induced spasticity to evaluate the efficacy of this procedure in reducing the tone of the spastic muscle groups.
Selective dorsal rhizotomy is well established effective procedure in participants with cerebral palsy associated spasticity.
As low and middle income countries, intrathecal baclofen pump is expensive for patients.
Spasticity is a condition that represents a form of disability and it's associated in various conditions. Intrathecal baclofen pump is tried and has a good outcome in treatment spasticity. However, it has some aide effects and complications and also expensive.
Selective dorsal rhizotomy is a surgical procedure that represents an optional treatment for spasticity and established with cerebral palsy and hereditary spasticity.
Selective dorsal rhizotomy in participants with Post traumatic induced spasticity isn't established yet and not compared with the results of intrathecal baclofen.
SDR is a procedure applied under general anesthesia and with neuromonitoring.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Selective dorsal rhizotomy parm | Experimental | This will be the enrolled group of patients that will match the eligibility criteria and give the consent to undergo the surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Selective dorsal rhizotomy with neuromonitoring | Procedure | In prone position and Under general anaesthesia, and according to neuromonitoring, a microscopic cut of the rootlet ( of the dorsal root of spinal nerve) that supply the group that is most spastic |
| Measure | Description | Time Frame |
|---|---|---|
| Change in spasticity severity assessed by the Modified Ashworth Scale (MAS) and electromyography (EMG) amplitude | The primary outcome will be the reduction in spasticity, quantified by the change in MAS scores and EMG muscle activity measurements from baseline to post-intervention. The MAS score, ranged from 0 to 4 as 0 represents no increase in muscle tone and 4 indicates rigid limb flexion/extension, will be reported as the mean change in points, and EMG data will be summarized using the mean and standard deviation of muscle activity amplitude during standardized stretch protocols. The data will be analyzed to determine the statistical significance of improvements following the selective dorsal rhizotomy procedure | From one week to six months post operative. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Afnan Morad | Contact | 01113890330 | afnanmrad45@gmail.com |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 37475737 | Background | He J, Luo A, Yu J, Qian C, Liu D, Hou M, Ma Y. Quantitative assessment of spasticity: a narrative review of novel approaches and technologies. Front Neurol. 2023 Jul 5;14:1121323. doi: 10.3389/fneur.2023.1121323. eCollection 2023. | |
| 41303128 | Background | Shourijeh MS, Stampas A, Chang SH, Korupolu R, Francisco GE. Advancements in Understanding Spasticity: A Neuromusculoskeletal Modeling Perspective. J Clin Med. 2025 Nov 15;14(22):8092. doi: 10.3390/jcm14228092. |
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| 24401159 | Background | Lindsay C, Simpson J, Ispoglou S, Sturman SG, Pandyan AD. The early use of botulinum toxin in post-stroke spasticity: study protocol for a randomised controlled trial. Trials. 2014 Jan 8;15:12. doi: 10.1186/1745-6215-15-12. |
| 28233010 | Background | Ertzgaard P, Campo C, Calabrese A. Efficacy and safety of oral baclofen in the management of spasticity: A rationale for intrathecal baclofen. J Rehabil Med. 2017 Mar 6;49(3):193-203. doi: 10.2340/16501977-2211. |
| 30460456 | Background | Enslin JMN, Langerak NG, Fieggen AG. The Evolution of Selective Dorsal Rhizotomy for the Management of Spasticity. Neurotherapeutics. 2019 Jan;16(1):3-8. doi: 10.1007/s13311-018-00690-4. |
| ID | Term |
|---|---|
| D009128 | Muscle Spasticity |
| D013119 | Spinal Cord Injuries |
| D000070642 | Brain Injuries, Traumatic |
| ID | Term |
|---|---|
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D009122 | Muscle Hypertonia |
| D020879 | Neuromuscular Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D020196 | Trauma, Nervous System |
| D014947 | Wounds and Injuries |
| D001930 | Brain Injuries |
| D001927 | Brain Diseases |
| D006259 | Craniocerebral Trauma |
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