Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity

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.

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Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity

Journal of Neurosurgery ◽

10.3171/jns.1998.88.6.1014 ◽

1998 ◽

Vol 88 (6) ◽

pp. 1014-1019 ◽

Cited By ~ 61

Author(s):

Nivedita Subramanian ◽

Christopher L. Vaughan ◽

Jonathan C. Peter ◽

Leila J. Arens

Keyword(s):

Cerebral Palsy ◽

Healthy Volunteers ◽

Video Data ◽

Spastic Diplegia ◽

Selective Dorsal Rhizotomy ◽

Content Type ◽

Dorsal Rhizotomy ◽

Normal Limits ◽

Children With Cerebral Palsy ◽

Fine Print

Object. 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. Methods. 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 healthy 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 healthy volunteers. The knee and hip ranges of motion (59° and 44°, respectively, for healthy volunteers) were significantly restricted in children with spastic diplegia prior to surgery (41° and 41°, respectively), but were within normal limits after 10 years (52° and 45°, respectively). The knee and hip midrange values (31° and 3°, respectively, for healthy volunteers), indicative of posture, were significantly elevated preoperatively (42° and 15°) and increased sharply at 1 year (56° and 18°), but by 10 years they had decreased to within normal limits (36° and 9°). Step length and velocity improved postoperatively but were not within the normal range after 10 years. Ten years after surgery these patients not only had increased ranges of motion, but also used that movement at approximately a normal midrange point. Conclusions. 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.

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Soft Tissue Release and Osteotomies in the Treatment of Patients with Spastic Diplegic Cerebral Palsy

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.12.004 ◽

2018 ◽

Vol 24 (1) ◽

pp. 80-83

Author(s):

Ng Bobby Kin-Wah ◽

Chau Wai-Wang ◽

Hung Alec Lik-Hang ◽

Lam Tsz-Ping ◽

Cheng Jack Chun-Yiu

Keyword(s):

Cerebral Palsy ◽

Soft Tissue ◽

Soft Tissue Release ◽

Spastic Diplegia ◽

Single Event ◽

Selective Dorsal Rhizotomy ◽

Dorsal Rhizotomy ◽

Surgery Patient ◽

Before And After ◽

Mid Term Results

We aim to study the outcome of soft tissue releases by tendon elongations and osteotomies in fixed joint contractures by clinical examination and patient self-reported assessment on 20 patients (14 males and 6 females) with spastic diplegic cerebral palsy treated with single-event multilevel surgery (SEMLS) between 2000 and 2012. A questionnaire was used to collect information on problems encountered before and after surgery and decision on surgery. Comparing patients with Gross Motor Function Classification System class I/II, (N = 8), III (N = 8) and IV/V, patients of classes IV/V showed much slower mean recovery time than I/II group (14.00 vs. 4.38 months, p < 0.01). SEMLS in the treatment of patients with spastic diplegia had good mid-term results in most patients. The patients who had unfavourable outcomes are associated with mental retardation, general or local complications and previous selective dorsal rhizotomy surgery. Patient selection and good rehabilitations preoperation and postoperation provided the most favourable outcomes of SEMLS.

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