Selective dorsal rhizotomy: long-term experience from Cape Town.
BACKGROUND
Given the large number of cerebral palsy patients who have undergone selective dorsal rhizotomy in the past two decades, it is clearly imperative that the clinical community be provided with objective and compelling evidence of the long-term sequelae of the procedure.


METHODS
In the early 1980s, Peacock in Cape Town shifted the site of the rhizotomy from the conus medullaris to the cauda equina, and in the past 25 years, more than 200 children have been operated on. We have studied the incidence of spinal deformities after multiple-level laminectomy and recorded a 20% incidence of isthmic spondylolysis or grade-I spondylolisthesis. We have also conducted a long-term prospective gait analysis study on a cohort of 14 ambulatory patients who were operated on in 1985.


RESULTS
Ten years after surgery, our patients had increased ranges of motion that were within normal limits. Step length was significantly improved, although cadence was unchanged postoperatively and was significantly less than normal age-matched control subjects.


CONCLUSIONS
We have recently tracked down all 14 patients from the original cohort and are currently completing a 20-year prospective follow-up analysis of their neuromuscular function and gait. Our preliminary data suggest that selective dorsal rhizotomy is not only an effective method for alleviating spasticity but it also leads to long-term functional benefits.
Langerak
Nelleke G
NG
MRC/UCT Medical Imaging Research Unit, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, Western Cape, 7925, South Africa.
Lamberts
Robert P
RP
Fieggen
A Graham
AG
Peter
Jonathan C
JC
Peacock
Warwick J
WJ
Vaughan
Christopher L
CL
D002420:Cauda Equina / Q000601:surgery*; D002547:Cerebral Palsy / Q000453:epidemiology / Q000266:history / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D049673:History, 20th Century; D006801:Humans; D015994:Incidence; D010372:Pediatrics; D012189:Retrospective Studies; D019051:Rhizotomy / Q000009:adverse effects / Q000266:history / Q000379:methods*; D013019:South Africa / Q000453:epidemiology; D013168:Spondylolisthesis / Q000453:epidemiology / Q000209:etiology; D013169:Spondylolysis / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome