Selective dorsal rhizotomy is a neurosurgical procedure performed for the relief of spasticity in children with cerebral palsy, but its long-term functional efficacy is still unknown. The authors sought to address this issue by means of an objective, prospective study in which quantitative gait analysis was used. Eleven children with spastic diplegia (mean age at initial surgery 7.8 years) were evaluated preoperatively in 1985 and then at 1, 3, and at least 10 years after surgery. For comparison, 12 age-matched normal individuals were also studied. Retroreflective targets were placed over the hip, knee, and ankle joints, and each individual's gait was videotaped. The video data were subsequently entered into a computer for extraction and analysis of the gait parameters. An analysis of variance yielded a significant time effect (p < 0.05), and post hoc comparisons revealed differences before and after surgery and with respect to the normal control subjects. The knee and hip ranges of motion (59š and 44š, respectively, for controls) were significantly restricted prior to surgery (41š and 41š, respectively), but were within normal limits after 10 years (52š and 45š, respectively). The knee and hip midrange values (31š and 3š, respectively, for controls), indicative of posture, were significantly elevated preoperatively (42š and 15š) and increased sharply at 1 year (56š and 18š), but by 10 years they had decreased to within normal limits (36š and 9š). Step length and velocity improved postoperatively but were not within the normal range after 10 years. Ten years after surgery our patients not only had increased ranges of motion, they also used that movement about a normal midrange point. Selective dorsal rhizotomy is an effective method for alleviating spasticity; furthermore, the authors provide evidence to show that lasting functional benefits, as measured by improved gait, can also be obtained.
Soft Tissue Release and Osteotomies in the Treatment of Patients with Spastic Diplegic Cerebral Palsy