title: Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience.
abstract: BACKGROUND
  Although three randomised control trials have shown that selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy, a meta-analysis of the results demonstrated that the procedure conferred only small functional benefit on the patient.
  
  
  OBJECTIVE
  To determine whether applying strict criteria for patient selection as practised in Oswestry leads to improved outcomes, using gait analysis as an outcome measure.
  
  
  METHODS
  Ambulant children with cerebral palsy were selected for SDR using very strict clinical criteria. Instrumented gait analysis was used as the main outcome measure.
  
  
  RESULTS
  Of 53 children referred for the procedure, only 19 (35%) fulfilled our strict criteria for selection. These children underwent surgery and when pre- and post-SDR data were compared, they showed improvement in cosmesis of gait, clinical examination and temporal, kinetic and kinematic parameters of gait. After SDR the children walked, on average, 0.15 m/s faster, with a step length improvement of 0.11 m. Changes were seen at hip, knee and ankle, with those at the knee being most marked. A 0.3 grade improvement in knee extensor power on clinical examination led to a 13 degrees improvement in stance phase knee extension. Knees also became less stiff, with an 82 degrees /s improvement in the rate of flexion into swing phase. A functional tool (the GMFCS) applied retrospectively also confirmed post-operative improvement, with 15 of the 19 children improving by at least one level.
  
  
  CONCLUSIONS
  Application of strict selection criteria when considering children for SDR leads to encouraging results as demonstrated by gait analysis and other measures.
authors.affiliation: ORLAU, RJAH Orthopaedic Hospital, Oswestry, Shropshire, UK.
authors.forename: G F
authors.initials: GF
authors.lastname: Cole
authors.forename: S E
authors.initials: SE
authors.lastname: Farmer
authors.forename: A
authors.initials: A
authors.lastname: Roberts
authors.forename: C
authors.initials: C
authors.lastname: Stewart
authors.forename: J H
authors.initials: JH
authors.lastname: Patrick
mesh_terms: D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D020233:Gait Disorders, Neurologic / Q000601:surgery*; D006801:Humans; D008297:Male; D018579:Patient Selection; D010808:Physical Examination; D019051:Rhizotomy / Q000379:methods*; D016896:Treatment Outcome