title: Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP).
  
  
  METHODS
  Nineteen children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and 10 years after SDR. Assessments included the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure 88 (GMFM-88) and the Wilson gait scale for ambulation, neurological investigations, and passive joint range of motion assessment. A 10-year retrospective chart review was added for orthopaedic surgery after SDR.
  
  
  RESULTS
  Baseline muscle tone at the hip, knee, and ankle level displayed a high degree of spasticity that normalized after SDR. After 10 years there was a slight recurrence of spasticity at the knee and ankle. Joint range of motion declined from a maximum at 3 years after SDR to the 10-year follow-up. Median ambulatory status was best 3 years after SDR and then declined. The GMFM-88 score increased from the median baseline value of 51 to 66 (p=0.002) and 76 (p<0.001) at the initial follow-ups. After 10 years there was a decline in gross motor function with a reduction in the GMFM-88 score to 62 (p=0.022). Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries (SD 2.8), soft tissue surgery being the most common.
  
  
  CONCLUSIONS
  The spasticity-reducing effect of SDR, although pronounced, did not seem to improve long-term functioning or prevent contractures. This suggests that contracture development in CP is not mediated by spasticity alone.
authors.affiliation: Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden. kristina.tedroff@ki.se
authors.forename: Kristina
authors.initials: K
authors.lastname: Tedroff
authors.forename: Kristina
authors.initials: K
authors.lastname: Löwing
authors.forename: Dan N O
authors.initials: DN
authors.lastname: Jacobson
authors.forename: Eva
authors.initials: E
authors.lastname: Åström
mesh_terms: D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D005684:Gait; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology*; D019637:Orthopedic Procedures / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D019051:Rhizotomy / Q000009:adverse effects*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome