Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure.
OBJECTIVE
Selective posterior rhizotomy (SPR) may result in considerable benefit for children with spastic cerebral palsy. To date, however, there have been few studies in which validated functional outcome measures have been used to report surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine long-term functional performance outcomes in patients who underwent lumbosacral dorsal rhizotomy performed using intraoperative electrophysiological monitoring.


METHODS
The study population was composed of children with debilitating spasticity who underwent SPR and were evaluated by a multidisciplinary team preoperatively and at 6 months and 1 year postoperatively. Quantitative standardized assessments of activities of daily living (ADL) were obtained using the Pediatric Evaluation of Disability Inventory (PEDI). Of 57 patients who met the entry criteria for the study, 41 completed the 3-year assessments and 30 completed the 5-year assessments. Statistical analysis demonstrated significant improvement in the mobility and self-care domains of the functional skills dimension at 1 year after SPR. The preoperative and 1-, 3-, and 5-year postoperative scaled scores for the mobility domain were 56, 64, 77.2, and 77.8, respectively. The scaled score for the self-care domain increased from 59 presurgery to 67.9, 81.6, and 82.4 at the 1-, 3-, and 5-year postoperative assessments, respectively.


CONCLUSIONS
The results of this study support the presence of significant improvements in functional performance, based on PEDI scores obtained 1 year after SPR. The improvements persisted at the 3- and 5-year follow-up examinations. The authors conclude that SPR performed using intraoperative stimulation is valuable in the augmentation of motor function and self-care skills essential to the performance of ADL.
Mittal
Sandeep
S
Division of Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Quebec, Canada.
Farmer
Jean-Pierre
JP
Al-Atassi
Borhan
B
Montpetit
Kathleen
K
Gervais
Nathalie
N
Poulin
Chantal
C
Benaroch
Thierry E
TE
Cantin
Marie-André
MA
D000203:Activities of Daily Living; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D002547:Cerebral Palsy / Q000188:drug therapy / Q000534:rehabilitation* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000601:surgery; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D010027:Osteotomy; D011183:Postoperative Complications; D020127:Recovery of Function; D015203:Reproducibility of Results; D019051:Rhizotomy; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins