title: [Rhizotomy for children with severe spastic cerebral palsy].
abstract: BACKGROUND
  Severe spasticity is a limiting factor for motor development in children with spastic cerebral palsy. Botulinum toxin, intrathecal baclofen and peroral baclofen all reduce spasticity but might also limit improvements in functional development over time. In the selective dorsal or posterior rhizotomy (SDR) approach, afferent sensory nerve fibers are cut while efferent motor fibers are preserved. In this way spasticity is reduced and motor functions can improve. SDR is an established treatment method, and the first Danish study is reported.
  
  
  METHODS
  Twenty Danish children with severe spastic cerebral palsy were evaluated, operated on and trained over a 10-year period from 1992 to 2002. Those on whom operation was performed ranged from 4 to 16 years of age (median 8 years), and training and follow-up took place during the ensuing 60 months. At time of operation, 20-40% of 100-120 dorsal root filaments were cut, corresponding to the II-V lumbar and I-II sacral nerve roots.
  
  
  RESULTS
  Spasticity in the lower extremities measured before SDR showed an average Asworth score of 2.0-4.2 (median 3.1). Eighteen months after SDR, scores were 0.8-1.8 (median 1.0), and at 60 months 0.8-1.8 (median 1.0). Both post-operative values were significant (t-test, p < 0.001). Mobility improved over a longer period of time: the Illinois St. Louis scale values before SDR were 1-9 (median 6), while at 18 months post-operative they were 1-9 (median 5) and at 60 months post-operative 1-9 (median 4). At 18 months, scores were non-significant (t test, p > 0.05), but at 60 months they were significant (t < 0.05). According to the Montgomery scale, 4 children had worse post-operative scores and 12 children had better scores. When comparing age at operation with outcome, we observed a certain degree of concordance between relatively younger age and better post-operative muscular function (Pearson's r = 0.8).
  
  
  CONCLUSIONS
  SDR resulted in early and lasting reduction in spasticity in all 20 children operated upon. Improved muscular function, however, required training and time. Not until 60 months after operation were functional measures significantly better than the preoperative values.
authors.affiliation: Odense Universitetshospital, Børneafdeling H, Børneneurologisk Afsnit, Fysioterapiafdelingen, Odense. niels.illum@ouh.fyns-amt.dk
authors.forename: Niels Ove
authors.initials: NO
authors.lastname: Illum
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Torp-Pedersen
authors.forename: Steen
authors.initials: S
authors.lastname: Midholm
authors.forename: Peter E
authors.initials: PE
authors.lastname: Selmar
authors.forename: Kurt
authors.initials: K
authors.lastname: Simesen
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000601:surgery*; D019051:Rhizotomy / Q000379:methods*; D016896:Treatment Outcome