title: Orthopedic surgery after selective dorsal rhizotomy for spastic diplegia in relation to ambulatory status and age.
abstract: OBJECTIVE
  A retrospective study was performed to determine the following: 1) whether children who walk independently after selective dorsal rhizotomy (SDR) undergo fewer subsequent orthopedic operations than those who walk with assistance; and 2) the effect of age at SDR on the rate of orthopedic operations.
  
  
  METHODS
  The cases of 158 children with spastic diplegia who were 2 to 14 years of age when they underwent SDR were followed over a 5- to 9-year period. Patients were grouped by age at the time of SDR as follows: 2 to 3 years (Group 1), 4 to 7 years (Group 2), and 8 to 14 years (Group 3). Follow-up data showed that children in all age groups who walked independently after SDR underwent fewer orthopedic operations than did children who walked with assistance. Overall rates of orthopedic surgery 5 to 9 years after SDR at last follow up were 24% for independent walkers and 51% for assisted walkers. Two-way categorical analysis (age group by ambulation) yielded a highly significant effect of ambulation (p = 0.0003). Children in Group 1 needed the fewest orthopedic operations at follow-up evaluation. In the older age groups (Groups 2 and 3), those who walked independently at the time of SDR underwent fewer orthopedic operations after SDR than did walkers who required assistance (p = 0.01).
  
  
  CONCLUSIONS
  These data are of value in advising parents about the likelihood of orthopedic surgery based on the child's gait status both at the time of SDR and at follow-up evaluation. Orthopedic surgery is more likely in patients destined to be nonambulators.
authors.affiliation: Department of Neurosurgery, St. Louis Children's Hospital St. Louis, Missouri 63110-1077, USA.
authors.forename: Donncha F
authors.initials: DF
authors.lastname: O'Brien
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Park
authors.forename: Joan A
authors.initials: JA
authors.lastname: Puglisi
authors.forename: David R
authors.initials: DR
authors.lastname: Collins
authors.forename: Eric C
authors.initials: EC
authors.lastname: Leuthardt
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000367:Age Factors; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D005500:Follow-Up Studies; D006801:Humans; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D012086:Reoperation; D012189:Retrospective Studies; D019051:Rhizotomy; D016138:Walking