title: A prospective gait analysis study in patients with diplegic cerebral palsy 20 years after selective dorsal rhizotomy.
abstract: OBJECTIVE
  Selective dorsal rhizotomy (SDR) has been widely performed for the reduction of spasticity in patients with cerebral palsy during the past 2 decades. The objective of this study was to determine whether the surgery has yielded long-term functional benefits for these patients.
  
  
  METHODS
  The authors present results from a prospective 20-year follow-up study of locomotor function in 13 patients who underwent an SDR in 1985. For comparison, we also present gait data for 48 age-matched healthy controls (12 at each of 4 time points). Patients were studied preoperatively and then at 1, 3, 10, and 20 years after surgery. Study participants were recorded in the sagittal plane while walking using a digital video camera, and 6 standard gait parameters were measured.
  
  
  RESULTS
  In this group of patients 20 years after surgery, knee range of motion (ROM) was on average 12 degrees greater than preoperative values (p < 0.001). Hip ROM before surgery was no different from that in the healthy control group. This parameter increased markedly immediately after surgery (p < 0.001) but had returned to normal after 20 years. The knee and hip midrange values-a measure of the degree of "collapse" due to muscle weakness after surgery-had returned to preoperative levels after 20 years, although they were respectively 11 and 8 degrees greater than those in healthy controls. Both temporal-distance parameters (dimensionless cadence and dimensionless step length) were significantly greater at 20 years than preoperative values (cadence, p = 0.003; step length, p = 0.02), leading to improved walking speed.
  
  
  CONCLUSIONS
  Twenty years after undergoing SDR, our patients showed improved locomotor function compared with their preoperative status.
authors: Medical Research Council/University of Cape Town Medical Imaging Research Unit, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Western Cape, South Africa.
authors: Nelleke G
authors: NG
authors: Langerak
authors: Robert P
authors: RP
authors: Lamberts
authors: A Graham
authors: AG
authors: Fieggen
authors: Jonathan C
authors: JC
authors: Peter
authors: Lize
authors: L
authors: van der Merwe
authors: Warwick J
authors: WJ
authors: Peacock
authors: Christopher L
authors: CL
authors: Vaughan
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000601:surgery*; D015331:Cohort Studies; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000503:physiopathology; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008124:Locomotion / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D018908:Muscle Weakness / Q000503:physiopathology; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D019051:Rhizotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording; D016138:Walking / Q000502:physiology