Long-term functional outcome after selective posterior rhizotomy.
OBJECTIVE
Selective posterior rhizotomy (SPR) is a well-recognized treatment for children with spastic cerebral palsy (CP). Few investigators have used quantitative outcome measures to assess the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term functional outcome of children who had undergone selective dorsal rhizotomy accompanied by intraoperative electrophysiological monitoring.


METHODS
The study population was composed of children with spastic CP who underwent SPR and were evaluated by a multidisciplinary team preoperatively, and at 6 months and 1 year postoperatively. Quantitative standardized assessments of lower-limb spasticity, passive range of motion, muscle strength, and ambulatory function were obtained. Of the 93 patients who met the entry criteria for the study, 71 completed the 3-year and 50 completed the 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in spasticity, range of motion, and functional muscle strength at 1 year after SPR. The preoperative, 1-, 3-, and 5-year values for the global score of the Gross Motor Function Measure were 64.6, 70.8, 80, and 85.6, respectively. The greatest improvement occurred in the dimensions reflecting lower-extremity motor function, where the mean change was 10.1% at 1 year, 19.9% at 3 years, and 34.4% at the 5-year follow-up review in comparison with the baseline value. This was associated with a lasting improvement in alignment and postural stability during developmental positions, as well as increased ability to perform difficult transitional movements.


CONCLUSIONS
The results of this study support the presence of significant improvements in lower-limb functional motor outcome 1 year after SPR, and the improvements persist at 3 and 5 years. The authors conclude that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function.
Mittal
Sandeep
S
Division of Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Quebec, Canada.
Farmer
Jean-Pierre
JP
Al-Atassi
Borhan
B
Gibis
Joanne
J
Kennedy
Eileen
E
Galli
Carlo
C
Courchesnes
Guylaine
G
Poulin
Chantal
C
Cantin
Marie-André
MA
Benaroch
Thierry E
TE
D002547:Cerebral Palsy / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004594:Electrophysiology; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D016343:Monitoring, Intraoperative; D009043:Motor Activity / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D020671:Posterior Horn Cells / Q000503:physiopathology* / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D019051:Rhizotomy; D013997:Time Factors