Arch Dis Child. Published Online First: 2 May 2007. doi:10.1136/adc.2006.111559
Original articles |
Selective dorsal rhizotomy for children with cerebral palsy: The Oswestry experience
1 ORLAU, United Kingdom
* To whom correspondence should be addressed. E-mail: caroline.stewart{at}rjah.nhs.uk.
Accepted 12 April 2007
Abstract
Background:Although three randomised control trials have shown that SDR reduces spasticity in children with cerebral palsy, a meta-analysis of the results demonstrated that the procedure conferred only small functional benefit on the patient.
Aim:To determine whether applying strict criteria for patient selection as practised in Oswestry leads to improved outcomes, using gait analysis as an outcome measure.
Methods:Ambulant children with cerebral palsy were selected for selective dorsal rhizotomy using very strict clinical criteria and instrumented gait analysis was used as the main outcome measure.
Results:Of 53 children referred for the procedure only 19 (35%) fulfilled our strict criteria for selection. These children underwent surgery and when pre and post SDR data were compared they showed improvement in cosmesis of gait, clinical examination, temporal, kinetic and kinematic parameters of gait. Post SDR the children walked, on average, 0.15m/s faster, with a step length improvement of 0.11m. Changes were seen at hip, knee and ankle, but those at the knee were most marked. A 0.3 grade improvement in knee extensor power on clinical examination led to a 13° improvement in stance phase knee extension. Knees also became less stiff, with an 82°/s improvement in the rate of flexion into swing phase. A functional tool (GMFCS) applied retrospectively also confirmed post operative improvement, with 15 of the 19 children improving by at least one level.
Conclusion:Application of strict selection criteria when considering children for SDR leads to encouraging results as demonstrated by gait analysis and other measures.
Keywords: Cerebral Palsy, Gait analysis, Selection Criteria, Selective Dorsal Rhizotomy
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