Neurosurgical Management of Childhood Spasticity: Functional Posterior Rhizotomy and Intrathecal XXXX Infusion Therapy.

@entity1 @entity508 @entity693 @entity5254 @entity3519 @entity1772 @entity306
A paradigm shift is currently ongoing in the treatment of @entity508 in childhood in Japan. Functional posterior rhizotomy (FPR), which was first introduced to Japan in 1996, is best indicated for @entity1 with @entity306 , regardless of the clinical severity of @entity508 . Surgery is generally carried out in the cauda equina, where the posterior root is separated from the anterior one, and neurophysiological procedures are used to judge which nerve root/rootlet should be cut. The outcome of FPR is favorable for reducing @entity508 in the long-term follow-up. Intrathecal @entity1772 (ITB) treatment for childhood @entity508 was approved in 2007 in Japan and the number of @entity1 undergoing ITB pump implantation has been gradually increasing. ITB treatment is best indicated for @entity1 with severe @entity508 , especially those with @entity3519 , regardless of the pathological background. Since it is a surgery performed to implant foreign bodies, special attention should be paid to avoid perioperative complications such as @entity5254 , @entity693 , and mechanical failure. Severely disabled @entity1 with @entity508 would benefit most from ITB treatment. We would especially like to emphasize the importance of a strategic approach to the treatment of childhood @entity508 . The first step is to reduce @entity508 by FPR, ITB, and botulinum toxin injection. The second step is to aim for functional improvement after controlling @entity508 . Traditional orthopedic surgery and neuro-rehabilitation form the second step of treatment. The combination of these treatments that allows them to complement each other is the key to a successful treatment of childhood @entity508 .
