Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy.
If the spasticity of cerebral palsy (CP) is reduced in children at a young age by selective dorsal rhizotomy, the incidence of lower-extremity deformities requiring orthopedic surgery may be reduced; however, this has never been investigated in detail. The authors examined the effects of selective dorsal rhizotomy on rates of lower-extremity orthopedic surgery in 178 children with CP. Age at selective dorsal rhizotomy ranged from 2 to 19.3 years (mean 5.5 years) with follow-up intervals ranging from 24 to 70 months (mean 44 months). Spastic CP was classified as quadriplegia (33%), diplegia (65%), and hemiplegia (2%). To assess the effects of early versus late rhizotomy on rates of orthopedic surgery, patients were grouped as follows: Group I underwent rhizotomy between 2 and 4 years of age (54 patients), and Group II underwent rhizotomy between 5 and 19 years of age (124 patients). Comparison of Kaplan-Meier plots of lifetime orthopedic surgery rates revealed that Group II underwent orthopedic surgery at a higher rate than Group I (p = 0.037). Analysis by procedure type revealed higher orthopedic surgery rates in Group II than Group I for heel cord releases (p = 0.0025), adductor releases (p = 0.018), and hamstring releases (p = 0.02). Orthopedic surgery rates were no higher for Group II compared to Group I for ankle/foot operations (p = 0.023), femoral osteotomy (p = 0.25), iliopsoas releases (p = 0.35), and "other" operations (p = 0.013). The data indicate that early rhizotomy reduces the need for orthopedic surgery for heel cord, hamstring, and adductor releases.
Chicoine
M R
MR
Department of Neurosurgery, St. Louis Children's Hospital, Washington University School of Medicine, Missouri, USA.
Park
T S
TS
Kaufman
B A
BA
D000293:Adolescent; D001132:Arm / Q000601:surgery; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005530:Foot Deformities / Q000601:surgery; D006429:Hemiplegia / Q000601:surgery; D006801:Humans; D007866:Leg / Q000601:surgery; D009128:Muscle Spasticity; D009985:Orthopedics / Q000706:statistics & numerical data*; D012086:Reoperation; D012189:Retrospective Studies; D019051:Rhizotomy