Long-Term Outcome after Selective Posterior Rhizotomy in Children with Spastic Cerebral Palsy

Abstract

A retrospective analysis of data collected prospectively was performed to determine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population comprised children with spastic CP, who had SPR more than 4 years prior to the time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically, muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the same measures. Hip adductor spasticity, hip abduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entry criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-year values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2.1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and quadriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed to be better at 1 and 5 years compared to baseline, but no statistical analysis was done for this secondary outcome measure. It was concluded that improvements in lower limb motor outcome are present at 1 year after SPR, and that these improvements are generally maintained at 5 years.

Supracondylar femoral extension osteotomy and patellar tendon advancement in the management of persistent crouch gait in cerebral palsy

“…Although MMT is not a consistent measure of strength in patients with neurological disorders, there have been studies where strength has been measured in MMT 1920. Subjects were allowed to lean back until tension in the hamstrings was relieved.…”

Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

“…However, the results in the body function and structure domain were not mentioned separately for the patients in the control group. Six further Level IV studies including 244 patients reported outcomes in the domain of body structure and body function 10,14,18,21,23,25 . A significant decrease in spasticity and range of motion was found was found 5 years after SDR in four studies 10,18,19,21 and in one study 20 years after SDR 14 .…”

“…Six further Level IV studies including 244 patients reported outcomes in the domain of body structure and body function 10,14,18,21,23,25 . A significant decrease in spasticity and range of motion was found was found 5 years after SDR in four studies 10,18,19,21 and in one study 20 years after SDR 14 . One Level IV study reported a significant improvement of gait performance in a subgroup of children that have been younger than 5 years old when SDR was performed 23 .…”

Comparison of Motor Outcomes after Selective Dorsal Rhizotomy with and without Preoperative Intensified Physiotherapy in Children with Spastic Diplegic Cerebral Palsy

“…This intragroup variability in the time between baseline and the most recent assessment was not considered to be a significant confounder, since it has been found previously that by 1 year after SDR, the patient’s condition has stabilized and an accurate assessment of the effect of the operation can be made [5, 21]. Another confounder was the fact that 6 children in group 1 and 3 in group 2 had intervening orthopedic procedures that may have affected the outcomes.…”