Incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective dorsal rhizotomy

Abstract

Except for spondylolisthesis, spinal deformities did appear to progress with time. However, this increase was not marked, and the development of relatively mild scoliosis was the only statistically significant increase. This group of patients requires continued follow-up. Further studies are required to ascertain the natural history of spinal deformity in adults with spastic diplegia who have not had SDR.

Gait status 17–26 years after selective dorsal rhizotomy

“…A substantial number of participants exhibited weakness, with most apparent impairments in gluteus muscles and hamstrings, possibly contributing to the crouched gait pattern as described for the participants in the SDR group. In addition, impaired hip abductor strength was also observed 17 years after SDR [14], which is in line with the lack of hip abduction in late stance as reported in our SDR group.…”

“…The influence of SDR on muscle strength is debatable, and varying outcomes ranging from deterioration, unchanged, or improvements in strength during the first years after surgery, have been reported [6,8]. Unfortunately, no pre-operative muscle strength assessment data was available for the current SDR group, but we do have information about muscle strength more than 17 years after SDR [14]. A substantial number of participants exhibited weakness, with most apparent impairments in gluteus muscles and hamstrings, possibly contributing to the crouched gait pattern as described for the participants in the SDR group.…”

“…None of the participants had sexual, bowel, or bladder function problems related to the SDR. As described by Langerak et al [14], there was an increase in spinal deformities, but only a statistically significant increase for relatively mild scoliosis was identified. Based on physical examination no hip displacements were identified more than 17 years after SDR.…”

“…A 20 year SDR follow-up study showed positive long-term functional results [14][15][16][17][18]. However, for these studies, the authors were dependent on assessment tools used in the 1980s, which were limited to two-dimensional (2D) gait data [16] and functional assessment tools [17].…”

65 Surgical Management of Spasticity

“…The long-term review of patients revealed a high incidence of minor scoliotic curves at a minimum of 17 years post-rhizotomy [30]. Generally, there is a relationship between the severity of involvement and the incidence of scoliosis [31,32].…”