Spinal deformity after selective dorsal rhizotomy in ambulatory patients with cerebral palsy.
Thirty-four patients with ambulatory spastic diplegia (ages 10-19.8 years) who were part of a prospective study of selective dorsal rhizotomy (SDR) had standardized radiographs before and after SDR. Follow-up ranged from 5 to 11.6 years after surgery. Two different surgical approaches were used: laminectomy (14 patients) and laminoplasty (20 patients). Radiographs were measured for coronal and sagittal balance. Thirty patients had a spinal deformity at long-term follow-up compared with 10 patients before surgery. Seventeen patients (50%) developed lumbar hyperlordosis greater than 60 degrees. Six patients (18%) developed grade 1 spondylolisthesis, Scoliosis occurred de novo in eight patients (24%) and progressed by greater than 5 degrees in two patients with preoperative scoliosis. No significant differences were found between laminoplasty and laminectomy patients. None of the patients have undergone any surgical intervention for spinal deformity. There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up.
Department of Orthopaedics, Royal Children's Hospital, Parkville, Victoria, Australia. michael_johnson@rch.org.au
Michael B
MB
Johnson
Liav
L
Goldstein
Susan Sienko
SS
Thomas
Joseph
J
Piatt
Michael
M
Aiona
Michael
M
Sussman
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D001416:Back Pain / Q000209:etiology; D017760:Bone Malalignment / Q000209:etiology; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods; D008141:Lordosis / Q000209:etiology; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods*; D012600:Scoliosis / Q000209:etiology; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D013131:Spine / Q000002:abnormalities* / Q000601:surgery; D013168:Spondylolisthesis / Q000209:etiology; D016896:Treatment Outcome