title: Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy.
abstract: OBJECTIVE
  The purpose of this study is to evaluate long-term outcomes after selective dorsal rhizotomy (SDR) for children with spastic cerebral palsy.
  
  
  METHODS
  This is a retrospective review of a prospective database of patients who underwent SDR at British Columbia Children's Hospital. Hip adductor spasticity, hip range of motion (ROM), quadriceps strength, and motor function were assessed pre-operatively, at 6 months to 5 years and more than 10 years postoperatively. Patients were stratified by Gross Motor Function Classification System (GMFCS) level into group 1 (GMFCS II and III) and group 2 (GMFCS IV and V).
  
  
  RESULTS
  Forty-four patients, with mean age at SDR of 4.5 years (range 2.9-7.7), were followed for a mean 14.4 years. Spasticity (Modified Ashworth Scale) decreased 1.5 (p < 0.0001) by early postoperative evaluation with further decrease at late evaluation of 0.8 (p < 0.0001). Early improvement in hip ROM of 13.7 degrees (p < 0.0001) was not sustained at late assessment. Motor function improved in both groups at early assessment but was only sustained in group 1. Group 1 increased 10.0 points (p < 0.0001) at early evaluation with subsequent decrease of 3.5, resulting in an overall increase of 6.6 (p = 0.04) from baseline. Group 2 patients had an initial increase of 8.3 [2.0, 14.6] (p = 0.01) but then declined to 4.9 below baseline (p = 0.3).
  
  
  CONCLUSIONS
  SDR yields durable reduction in spasticity after 10 years. Early improvements in motor function are present, but at long-term follow-up, these improvements were attenuated in GMFCS II and III and were not sustained in GMFCS IV and V.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and British Columbia Children's Hospital, 4480 Oak St., Room K3-159, Vancouver, BC, V6H 3V4, Canada.
authors.forename: Tamir
authors.initials: T
authors.lastname: Ailon
authors.forename: Richard
authors.initials: R
authors.lastname: Beauchamp
authors.forename: Stacey
authors.initials: S
authors.lastname: Miller
authors.forename: Patricia
authors.initials: P
authors.lastname: Mortenson
authors.forename: John M
authors.initials: JM
authors.lastname: Kerr
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Hengel
authors.forename: Paul
authors.initials: P
authors.lastname: Steinbok
mesh_terms: D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D053580:Muscle Strength; D016059:Range of Motion, Articular; D019051:Rhizotomy / Q000379:methods*; D016896:Treatment Outcome