Selective dorsal rhizotomy (SDR) and non-SDR groups had significant improvement in gait pathology over time. The non-SDR group had significantly better gait compared with the SDR group at follow-up. The groups had similar levels of energy cost, pain, and quality of life. Non-SDR participants underwent significantly more orthopaedic surgery and antispasticity injections than SDR participants. Use of a clinically similar control group highlights that different treatment courses may result in similar outcomes into young adulthood.

Background Locomotor function is often impaired in children diagnosed with cerebral palsy (CP). Improving locomotor function is a common goal of treatment. The current gold standard for assessing locomotor function in CP is the gross motor function measure (GMFM-66). The GMFM-66 requires an in-person assessment by a trained clinician. It would be useful to have a measure of function that is like the GMFM-66 but can be assessed through patient report. Methods We queried the clinical databases of two motion analysis centers (Gillette Children's Specialty Healthcare and Shriners Hospital - Salt Lake City) for individuals with a diagnosis of cerebral palsy (CP) who were 18 years old or younger and had undergone instrumented clinical gait analysis that included the functional assessment questionnaire (FAQ). We computed the transformed FAQ (FAQt) as the weighted sum of the skills an individual was able to perform, where the weighting was the difficulty of the skills. We assessed concurrent and external validity of the FAQt by comparing it to the GMFM-66. Results The FAQt exhibited strong concurrent and external validity. Linear regression showed that the GMFM-66 explained 54% of the variance in FAQt, and the linear fit was independent of center. The FAQt evolved with age in a manner similar to the GMFM-66, with higher functioning individuals, as measured by gross motor function classification system level, achieving higher levels of function at a higher rate and an earlier age compared to their lower functioning peers. The findings with respect to GMFM-66 did not depend on the center at which the data was acquired. Conclusions The FAQt demonstrates strong concurrent and external validity, making it a useful measure of locomotor function

Aim To compare short‐term outcomes between conus medullaris (conus) and cauda equina (cauda) selective dorsal rhizotomy (SDR) techniques in children with spastic cerebral palsy. Method This was a retrospective review of SDR at a single center from 2013 to 2017. Gait and functional outcome measures were assessed at no more than 18 months pre‐SDR (baseline) and 8 to 36 months post‐SDR (follow‐up). Transient complications during inpatient stay were quantified. Results In total, 21 and 59 children underwent conus and cauda SDR respectively. Ashworth Scale scores were nearly normalized at follow‐up. Most physical examination and functional measures exhibited similar baseline to follow‐up responses for both groups. From baseline to follow‐up, sagittal plane knee kinematics for both groups significantly improved (p<0.01) by 11° at initial contact, 9° to 10° in stance phase, and 4° in swing phase. Sagittal plane ankle kinematics improved more for the cauda group than the conus group in both stance phase (10° vs 2°, p<0.01) and swing phase (13° vs 3°, p<0.01). Post‐surgical complications were similar between groups. Interpretation Conus and cauda SDR techniques resulted in similar short‐term outcomes except in ankle kinematics at follow‐up. The cauda group exhibited a large improvement towards dorsiflexion, while there was residual equinus in the conus group despite Ashworth Scale scores normalizing equally in both groups. What this paper adds Conus and cauda selective dorsal rhizotomy (SDR) resulted in mostly similar short‐term gait and functional outcomes. Conus SDR resulted in residual equinus dynamically, despite normalized spasticity measures. Post‐surgical complications were mostly similar between SDR techniques.