Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity

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Object. Selective dorsal rhizotomy is a neurosurgical procedure performed for the relief of spasticity in children with cerebral palsy, but its long-term functional efficacy is still unknown. The authors sought to address this issue by means of an objective, prospective study in which quantitative gait analysis was used.

Methods. Eleven children with spastic diplegia (mean age at initial surgery 7.8 years) were evaluated preoperatively in 1985 and then at 1, 3, and at least 10 years after surgery. For comparison, 12 age-matched healthy individuals were also studied. Retroreflective targets were placed over the hip, knee, and ankle joints, and each individual's gait was videotaped. The video data were subsequently entered into a computer for extraction and analysis of the gait parameters. An analysis of variance yielded a significant time effect (p < 0.05), and post hoc comparisons revealed differences before and after surgery and with respect to the healthy volunteers. The knee and hip ranges of motion (59° and 44°, respectively, for healthy volunteers) were significantly restricted in children with spastic diplegia prior to surgery (41° and 41°, respectively), but were within normal limits after 10 years (52° and 45°, respectively). The knee and hip midrange values (31° and 3°, respectively, for healthy volunteers), indicative of posture, were significantly elevated preoperatively (42° and 15°) and increased sharply at 1 year (56° and 18°), but by 10 years they had decreased to within normal limits (36° and 9°). Step length and velocity improved postoperatively but were not within the normal range after 10 years. Ten years after surgery these patients not only had increased ranges of motion, but also used that movement at approximately a normal midrange point.

Conclusions. Selective dorsal rhizotomy is an effective method for alleviating spasticity. Furthermore, the authors provide evidence to show that lasting functional benefits, as measured by improved gait, can also be obtained.

Article Information

Address reprint requests to: Christopher L. Vaughan, Ph.D., Department of Biomedical Engineering, University of Cape Town Medical School, Observatory 7925, Cape Town, South Africa. email: kvaughan@anat.uct.ac.za.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Illustrative definitions of the knee angle (A) and hip angle (B) for a child with spastic CP compared with a healthy (normal) child. These diagrams not only show the extremes of the range of movement, but also the midrange values for the knee and hip angles. Note that the angle at the knee joint was defined as the angle between the thigh and calf, whereas the hip angle was defined as the angle between the thigh and a vertical axis.

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    Graphs showing the mean data for the knee range of motion (upper) (with 1 standard deviation) and the hip midrange value (lower) (with 1 standard deviation) for 11 patients preoperatively and then at 1, 3, and 10 years after SDR. The mean data for 12 age-matched healthy (normal) volunteers are also included. This figure is based on the data demonstrated in Table 1.

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