Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience
- Dr Caroline Stewart, ORLAU, RJAH Orthopaedic Hospital, Oswestry, Shropshire SY10 7AG, UK;
- Accepted 12 April 2007
- Published Online First 2 May 2007
Background: Although three randomised control trials have shown that selective dorsal rhizotomy (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 SDR using very strict clinical criteria. 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 and temporal, kinetic and kinematic parameters of gait. After SDR the children walked, on average, 0.15 m/s faster, with a step length improvement of 0.11 m. Changes were seen at hip, knee and ankle, with those at the knee being 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 (the 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.
Competing interests: None.
All the work was carried out in the above institution, and the same contact details apply to all authors (Dr Gaynor Cole, Mrs Sybil Farmer, Mr Andrew Roberts, Dr Caroline Stewart, Mr John Patrick).
- Gross Motor Function Classification System
- Gross Motor Function Measure
- selective dorsal rhizotomy