Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively.
OBJECTIVE
Effects of selective dorsal rhizotomy (SDR) were studied in children with spastic cerebral palsy in orthopaedic and functional fields.


METHODS
In a prospective study, we compared the same population before SDR and 1 year after SDR. This population included children with spastic cerebral palsy, when spasticity was responsible for a halt in the motor skill acquisitions or for orthopaedic complications. All the children had intensive physiotherapy for 6 months postoperatively. We observed spasticity by a 4-point scale, isolation of movement by a 3-point scale, and orthopaedic status by the measure of range of motion, hip migration on the radiography, and function by Gross Motor Function Measure (GMFM) and Abbott scale. All the assessments were done by the same physiotherapist. We compared the results with a Wilcoxon statistic test.


RESULTS
18 quadriplegic children had spastic cerebral palsy; their mean age was 9 years (5.5-16.5 years). We observed a decrease in spasticity in all the muscular groups; increase in range of motion only on abduction and extension of the hips; no evolution of hip migration; an increase of 3.2% in the total GMFM score; 1 child was classified IV before SDR and V after SDR on the Abbott scale; 3 children had planned orthopaedic surgery in the year after SDR; 16 children and their families were highly satisfied with the result of the surgery.


CONCLUSIONS
The decrease in spasticity does not entail prevention of orthopaedic problems in children with quadriplegic spastic cerebral palsy. However, we observed an improvement in qualitative function that is outside the scope of current assessment scales.
Escale-Service de rééducation fonctionnelle pédiatrique, Centre Hospitalier Lyon-Sud, Lyon, France.
I
I
Hodgkinson
C
C
Bérard
M L
ML
Jindrich
M
M
Sindou
P
P
Mertens
J
J
Bérard
D002547:Cerebral Palsy / Q000534:rehabilitation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009048:Motor Skills; D009128:Muscle Spasticity / Q000534:rehabilitation / Q000601:surgery*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011446:Prospective Studies; D011782:Quadriplegia / Q000534:rehabilitation / Q000601:surgery; D016059:Range of Motion, Articular; D019051:Rhizotomy; D013126:Spinal Nerve Roots / Q000601:surgery; D018709:Statistics, Nonparametric; D016896:Treatment Outcome