title: Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term effect of selective dorsal rhizotomy (SDR) on the gross motor function of ambulant children with spastic bilateral cerebral palsy (CP), compared with reference centiles.
  
  
  METHODS
  The study used a prospective cohort design and participants comprised 29 children classified using the Gross Motor Function Classification System (GMFCS) in level I (n=7), II (n=4), or III (n=18; 18 males, 11 females; median age at time of surgery 6 y 4 mo; range 2 y 10 mo-12 y 1 mo), who were examined 5 years and 10 years after SDR. We used individual centiles based on Gross Motor Function Measure (GMFM-66) scores and age, corresponding to the GMFCS levels. Individual improvement or deterioration was defined as a change of more than 20 centiles. Side effects experienced and additional treatment received after SDR were also recorded.
  
  
  RESULTS
  Five years after SDR, 10 out of 28 children showed improvement, and 10 years after SDR 6 out of 20 children had improved. Spinal side effects were noted in two children and hip subluxation in three. Additional treatments included subtalar arthrodesis (n=13), endorotational osteotomy of the tibia (n=5), and botulinum toxin treatment (n=13).
  
  
  CONCLUSIONS
  None of the children showed deterioration of gross motor function based on centile ranking. Five and 10 years after SDR, gross motor function in some children had improved more than would have been expected according to the reference centiles. This suggests, taking the limitations of this study into account, that the applied criteria for selection were adequate. However, the children still required additional treatment after SDR.
authors.affiliation: Department of Rehabilitation Medicine, Physiotherapy Section, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Eline A M
authors.initials: EA
authors.lastname: Bolster
authors.forename: Petra E M
authors.initials: PE
authors.lastname: van Schie
authors.forename: Jules G
authors.initials: JG
authors.lastname: Becher
authors.forename: Willem J R
authors.initials: WJ
authors.lastname: van Ouwerkerk
authors.forename: Rob L M
authors.initials: RL
authors.lastname: Strijers
authors.forename: R Jeroen
authors.initials: RJ
authors.lastname: Vermeulen
mesh_terms: D002547:Cerebral Palsy / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills / Q000502:physiology*; D009069:Movement Disorders / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods*; D012720:Severity of Illness Index; D013126:Spinal Nerve Roots / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome