Preoperative MRI findings and functional outcome after selective dorsal rhizotomy in children with bilateral spasticity.
OBJECTIVE
To identify MRI characteristics that may predict the functional effect of selective dorsal rhizotomy (SDR) in children with bilateral spastic paresis.


METHODS
We performed SDR in a group of 36 patients. The gross motor functioning measure-66 (GMFM-66) was applied before and after SDR. Available cerebral MRIs were retrospectively classified into three diagnostic groups: periventricular leucomalacia (PVL; n = 10), hydrocephalus (n = 2), and normal (n = 6). In patients with PVL, we scored the severity of the MR abnormalities. We compared the changes in the GMFM-66 after SDR in the diagnostic groups. In patients with PVL, we correlated the severity of the MR abnormalities with the changes in the GMFM-66.


RESULTS
The mean follow-up period was 5 years and 4 months (range, 1 year and 1 month to 9 years). The best improvement in gross motor function was observed in patients with normal MRI, and the slightest improvement was observed in patients with hydrocephalus. The severity of the PVL did correlate with the GMFM-66 score before SDR but not with the functional effect of SDR.


CONCLUSIONS
We conclude that with respect to gross motor skills, the improvements after SDR are good in patients with no MRI abnormalities. In the patients with hydrocephalus, the improvements after SDR were insignificant. In patients with PVL, the improvements were intermediate and did not correlate with the degree of PVL.
Grunt
Sebastian
S
Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Becher
Jules G
JG
van Schie
Petra
P
van Ouwerkerk
Willem J R
WJ
Ahmadi
Mazarin
M
Vermeulen
R Jeroen
RJ
D001921:Brain / Q000473:pathology*; D002648:Child; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009043:Motor Activity; D020336:Paraparesis, Spastic / Q000473:pathology* / Q000601:surgery*; D057234:Preoperative Period; D019051:Rhizotomy / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome