Orthopedic procedures after rhizotomy.
The goal of selective dorsal rhizotomy (SDR) is to reduce surgically abnormal excitatory impulses to the lower extremities and thus to decrease spasticity in patients with cerebral palsy. One hundred thirty-one patients underwent SDR from 1986 to 1994 and were retrospectively reviewed for changes in tone, requirements for orthopedic intervention, and changes in ambulatory status. One hundred twelve patients had adequate follow-up. Postrhizotomy tone was decreased in all of the 112 patients, as measured by the Ashworth scale. No statistically significant change in ambulatory status was found. A total of 71 (65%) of 112 patients required orthopedic intervention for continued contractures and deformity. Of those judged "hypotonic" by the physiatrist postoperatively, 37% required subtalar stabilization for severe planovalgus. Hip subluxation was noted and treated (by femoral or pelvic osteotomy or both) in 27 (25%) of 112. Despite appropriately completed SDR, parents must understand the importance of periodic long-term follow-up and the possible, if not likely, need for additional surgery to alleviate contractures and stabilize subluxation of joints.
Carroll
K L
KL
Primary Children's Medical Center, Salt Lake City, Utah, USA.
Moore
K R
KR
Stevens
P M
PM
D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000601:surgery; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures; D012086:Reoperation; D012189:Retrospective Studies; D019051:Rhizotomy; D016138:Walking