title: Gait status 17-26 years after selective dorsal rhizotomy.
abstract: The purpose of this study was to use three-dimensional gait analysis to describe the gait status of adults with spastic diplegia who underwent selective dorsal rhizotomy (SDR) in childhood. Outcome measures were the gait deviation index (GDI), non-dimensional temporal-distance parameters, and kinematics of the lower limbs. A total of 31 adults with spastic diplegia who had previously undergone SDR were eligible and participated in current study (SDR group). These participants had a median age of 26.8 years (range 21-44 years) with a mean time between surgery and assessment of 21.2±2.9 years (range 17-26 years). For comparison purposes, 43 typically developed adults also participated (CONTROL group), with a median age of 28.3 years (range 21-45 years). More than 17 years after SDR 58% of the SDR group showed improved GMFCS levels, while none of them deteriorated. The participants in the SDR group walked with a mild crouch gait, although there was a loading response, adequate swing-phase knee flexion, adequate swing-phase plantarflexion, reasonable speed and cadence. The gait status of the SDR group more than 17 years after SDR was similar to what has been reported in short-term follow-up studies, as well as our earlier 20 year follow-up study that did not include 3D gait analysis. Appropriate orthopaedic intervention was required in 61% of the study cohort. Whether the types and numbers of orthopaedic interventions are positively affected by SDR remains an open question. Further studies examining this question are warranted. In addition, long-term follow-up studies focused on other interventions would also be of clinical relevance.
authors: MRC/UCT Medical Imaging Research Unit, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa. Nellekelangerak@hotmail.com
authors: Nelleke G
authors: NG
authors: Langerak
authors: Nicholas
authors: N
authors: Tam
authors: Christopher L
authors: CL
authors: Vaughan
authors: A Graham
authors: AG
authors: Fieggen
authors: Michael H
authors: MH
authors: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000843:Ankle Joint / Q000503:physiopathology; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D018579:Patient Selection; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D019051:Rhizotomy / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013647:Task Performance and Analysis; D013997:Time Factors; D055815:Young Adult