Long-term outcomes five years after selective dorsal rhizotomy.
BACKGROUND
Selective dorsal rhizotomy (SDR) is a well accepted neurosurgical procedure performed for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP). The goal is to improve function, but long-term outcome studies are rare. The aims of this study were to evaluate long-term functional outcomes, safety and side effects during five postoperative years in all children with diplegia undergoing SDR combined with physiotherapy.


METHODS
This study group consisted of 35 children, consecutively operated, with spastic diplegia, of which 26 were Gross Motor Function Classification System (GMFCS) levels III-V. Mean age was 4.5 years (range 2.5-6.6). They were all assessed by the same multidisciplinary team at pre- and at 6, 12, 18 months, 3 and 5 years postoperatively. Clinical and demographic data, complications and number of rootlets cut were prospectively registered. Deep tendon reflexes and muscle tone were examined, the latter graded with the modified Ashworth scale. Passive range of motion (PROM) was measured with a goniometer. Motor function was classified according to the GMFCS and measured with the Gross Motor Function Measure (GMFM-88) and derived into GMFM-66. Parent's opinions about the children's performance of skills and activities and the amount of caregiver assistance were measured with Pediatric Evaluation Disability Inventory (PEDI).


RESULTS
The mean proportion of rootlets cut in S2-L2 was 40%. Muscle tone was immediately reduced in adductors, hamstrings and dorsiflexors (p < 0.001) with no recurrence of spasticity over the 5 years. For GMFCS-subgroups I-II, III and IV-V significant improvements during the five years were seen in PROM for hip abduction, popliteal angle and ankle dorsiflexion (p = 0.001), capacity of gross motor function (GMFM) (p = 0.001), performance of functional skills and independence in self-care and mobility (PEDI) (p = 0.001).


CONCLUSIONS
SDR is a safe and effective method for reducing spasticity permanently without major negative side effects. In combination with physiotherapy, in a group of carefully selected and systematically followed young children with spastic diplegia, it provides lasting functional benefits over a period of at least five years postoperatively.
Nordmark
Eva
E
Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden. eva.nordmark@med.lu.se
Josenby
Annika Lundkvist
AL
Lagergren
Jan
J
Andersson
Gert
G
Strömblad
Lars-Göran
LG
Westbom
Lena
L
D000203:Activities of Daily Living; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012021:Reflex, Abnormal / Q000502:physiology*; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods*; D013126:Spinal Nerve Roots / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors