Motor function after selective dorsal rhizotomy: a 10‐year practice‐based follow‐up study

Abstract

Aim The aim of this study was to explore changes in motor function up to 10 years after selective dorsal rhizotomy (SDR). Method The participants comprised 29 children (20 males, nine females) with bilateral spastic diplegia who were consecutively operated on at a median age of 4 years and 3 months and followed until a median age of 15 years. SDR was combined with physiotherapy and regular follow‐up visits. The distribution of preoperative Gross Motor Function Classification System (GMFCS) levels was as follows: I, n=1; II, n=7; III, n=8; IV, n=12; and V, n=1. Muscle tone in hip flexors, hip adductors, knee flexors, and plantar flexors was assessed with the modified Ashworth scale, passive range of motion in hip abduction, popliteal angle, maximum knee extension, dorsiflexion of the foot was measured with a goniometer, and gross motor function was assessed using the Gross Motor Function Measure (GMFM‐66). The results were compared with preoperative values, taking into account age at the time of SDR. Results After 10 years, muscle tone in hip flexors, hip adductors, knee flexors and plantar flexors was normalized in 19, 24, 13 and 23 participants respectively; mean change in passive range of motion ranged from −2.0° to 8.6°, and the mean increase in GMFM‐66 was 10.6. Changes in GMFM‐66 were associated with preoperative GMFCS level and GMFM‐66 scores. Interpretation Children who underwent SDR and physiotherapy and were regularly followed up by an experienced team showed improved gross motor function for up to 10 years postoperatively.

Excellent functional outcome following selective dorsal rhizotomy in a child with spasticity secondary to transverse myelitis

“…However, function (as measured with GMFM-88) seemed to improve sharply for up to 3 years after SDR but, thereafter, a significant reduction was witnessed. In a recent study the authors [9] showed that even 10 years after the operation, SDR, combined with physiotherapy in children with bilateral spastic diplegia, resulted in reduced muscle tone in the majority of patients assessed (n=29) and the mean increase in GMFM-66 was 10.6. The procedure led not only to reduced spasticity but also to improved gait for a decade after the operation [10].…”

Physical activity of children with cerebral palsy: what are the considerations?

“…The study by van Wely et al 1 is innovative in examining the effect of personal and environmental factors on physical activity. In their study, children with cerebral palsy who walk took fewer steps per day on weekends and fewer steps per day than recommendations for children without physical impairments.…”

“…Although van Wely et al 1 measured steps walked per day as an indicator of physical activity, their recommendation to increase physical activity on weekends is not specific to walking. A number of considerations underlie the question of whether a child with cerebral palsy should be encouraged to increase physical activity by walking more often or for longer periods.…”

“…The article by Stout et al 1 provides an excellent discussion of the International Classification of Functioning, Disability and Health (ICF) model, as it attempts to clarify use of the terms capacity, capability, and performance. These are important concepts when comparing results in studies.…”

Authors' reply to Crilly, and Willoughby and Graham

“…2 3 A recent prospective study also did not show improved scores in the Gross Motor Function Classification System (GMFCS) during 10 years of follow-up. 4 However, we knew of reports of children with spasticity experiencing sustained improvement in motor function after the procedure. These data suggested that children whose walking was primarily impaired by spasticity rather than weakness, contractures, or poor muscle control could benefit.…”