Selective dorsal rhizotomy versus orthopedic surgery: a multidimensional assessment of outcome efficacy.
OBJECTIVE
To compare the efficacy of selective dorsal rhizotomy (SDR) and orthopedic surgery using multidimensional (National Center for Medical Rehabilitation Research disablement framework) outcome measures.


METHODS
Prospective outcome study.


METHODS
Pediatric orthopedic hospital.


METHODS
Twenty-five children with spastic diplegia. Eighteen participants (mean age, 71.3 mo) chose SDR. Seven participants (mean age, 78.6 mo) chose orthopedic surgery.


METHODS
Children were evaluated 2 days before surgical intervention and at 6 months, 1 year, and 2 years postsurgically.


METHODS
The Gross Motor Performance Measure, the Gross Motor Function Measure, and the Pediatric Evaluation of Disability Inventory.


RESULTS
The SDR group improved significantly in quality of movement attributes 6 months postsurgically; however, gross motor skills (standing; walking, running, and jumping) gains were seen 2 years postsurgically. The orthopedic group improved significantly in select quality of movement attributes 6 months postsurgically and in standing skills within the first postsurgical year. Self-care skills, mobility, and social function gains were seen earlier and with greater frequency in the SDR group.


CONCLUSIONS
Both surgical interventions demonstrated multidimensional benefits for ambulatory children with spastic diplegia. The results suggest that qualitative changes in movement, achieved by spasticity reduction, have a greater effect on the enhancement of functional skill proficiency, thus independence, than recognized.
Buckon
Cathleen E
CE
Shriners Hospital for Children, Portland, OR, USA. ceb@shcc.org
Thomas
Susan Sienko
SS
Piatt
Joseph H
JH
Aiona
Michael D
MD
Sussman
Michael D
MD
D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology*; D019637:Orthopedic Procedures; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D019051:Rhizotomy; D013126:Spinal Nerve Roots / Q000601:surgery*