A prospective gait analysis study in patients with diplegic cerebral palsy 20 years after selective dorsal rhizotomy.
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.
Langerak
Nelleke G
NG
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.
Lamberts
Robert P
RP
Fieggen
A Graham
AG
Peter
Jonathan C
JC
van der Merwe
Lize
L
Peacock
Warwick J
WJ
Vaughan
Christopher L
CL
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