Comprehensive short-term outcome assessment of selective dorsal rhizotomy.
This study retrospectively evaluated the safety and efficacy of selective dorsal rhizotomy (SDR) in participants who underwent a rigorous selection process, uniform surgical procedure, and a standardized postoperative rehabilitation process. Outcome measures assessed were the Ashworth scale for spasticity, the Gillette Gait Index (GGI) for overall gait pathology, oxygen cost for gait efficiency, and the Gillette Functional Assessment Questionnaire (functional walking ability scale; [FAQ]) for functional mobility. Outcomes were evaluated for 136 children (81 males, 55 females; mean age 7y 3mo [SD 2y 1mo], range 3y 5mo-18y 9mo) for an average of 18.3 months (SD 4.4mo) postoperatively. All participants had a diagnosis of cerebral palsy (CP): 10 quadriplegia, 19 triplegia, and 107 diplegia. Preoperative Gross Motor Function Classification System levels were: Level I n=6; Level II n=64; Level III n=59, and Level IV n=7. All outcome measures improved for the group as a whole. Spasticity improved with 66 to 92% of possible gain in Ashworth scores; GGI was 7.5 times more likely to have a good as opposed to a poor outcome; energy efficiency improved in over half of the participants, and the FAQ demonstrated a statistically significant improvement of 0.9 levels (p<0.001). The rate of complications was low, with peri- and postoperative complications resolved by time of discharge.
Centre for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St Paul, MN, USA. Jtrost@gillettechildrens.com
Joyce P
JP
Trost
Michael H
MH
Schwartz
Linda E
LE
Krach
Mary E
ME
Dunn
Tom F
TF
Novacheck
D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D020233:Gait Disorders, Neurologic / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D019957:Motor Skills Disorders / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D012189:Retrospective Studies; D019051:Rhizotomy; D013126:Spinal Nerve Roots / Q000601:surgery; D016896:Treatment Outcome