Functional assessment of children with cerebral palsy following limited (L4-S1) selective posterior rhizotomy--a preliminary report.
OBJECTIVE
Selective Posterior Rhizotomy (SPR) is effective for reducing spasticity in children with cerebral palsy (CP). Nonetheless, extensive sensory deafferentation associated with this procedure can lead to prolonged postoperative hypotonia that delays the functional recovery of the patient. As lumbar rhizotomy provokes suprasegmental hypotonia, we hypothesized that reducing the extent of the deafferentation to the roots of L4-S1 levels would reduce the risk of postoperative hypotonia.


RESULTS
Five patients with spastic cerebral palsy (4 males and 1 females, age range: 4-12 years) underwent limited selective dorsal rhizotomy (LSDR) of three (L4-S1) dorsal roots. All patients were able to walk independently prior to surgery. Functional assessments of these patients were performed pre and post operatively. Assessments included spasticity evaluation, passive range of motion, and sagittal plane kinematics of the hip, knee, and ankle during walking. Following surgery, reduced spasticity, increased passive range of motion and improved joint motion during walking was observed. Specifically, peak hip and knee extension and peak ankle dorsiflexion increased while peak plantarflexion decreased.


CONCLUSIONS
Strength and motor control were not adversely affected by this procedure in any of the subjects and all patients actually demonstrated improvements. Previous studies have demonstrated that LSDR is highly effective in reducing spasticity and achieving functional outcome in spastic children. The results of this study demonstrated improved function during walking as assessed using gait analysis techniques.
Galarza
M
M
Division of Neurosurgery, University of California at Los Angeles (UCLA) School of Medicine, Los Angeles, California, USA.
Fowler
E G
EG
Chipps
L
L
Padden
T M
TM
Lazareff
J A
JA
D000553:Ambulatory Care; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005684:Gait / Q000502:physiology; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D009043:Motor Activity / Q000502:physiology; D009123:Muscle Hypotonia / Q000209:etiology* / Q000503:physiopathology; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D019051:Rhizotomy / Q000009:adverse effects*