%0 Journal Article %A G F Cole %A S E Farmer %A A Roberts %A C Stewart %A J H Patrick %T Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience %D 2007 %R 10.1136/adc.2006.111559 %J Archives of Disease in Childhood %P 781-785 %V 92 %N 9 %X 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. %U https://adc.bmj.com/content/archdischild/92/9/781.full.pdf