Long-term functional outcome after selective posterior rhizotomy

Sandeep Mittal M.D.1, Jean-Pierre Farmer M.D.1, Borhan Al-Atassi B.Sc.1, Joanne Gibis R.P.T., M.Sc.1, Eileen Kennedy R.P.T., B.Sc.1, Carlo Galli R.P.T., B.Sc.1, Guylaine Courchesnes R.N., B.Sc.1, Chantal Poulin M.D.1, Marie-André Cantin M.D.1, and Thierry E. Benaroch M.D.1
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  • 1 Divisions of Neurosurgery, Neurology, Orthopedics, Physiotherapy, and Nursing, Montreal Children's Hospital, McGill University Health Centre, and Shriners Hospital for Children, Montreal, Quebec, Canada
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Object. Selective posterior rhizotomy (SPR) is a well-recognized treatment for children with spastic cerebral palsy (CP). Few investigators have used quantitative outcome measures to assess the surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine the long-term functional outcome of children who had undergone selective dorsal rhizotomy accompanied by intraoperative electrophysiological monitoring.

Methods. The study population was composed of children with spastic CP who underwent SPR and were evaluated by a multidisciplinary team preoperatively, and at 6 months and 1 year postoperatively. Quantitative standardized assessments of lower-limb spasticity, passive range of motion, muscle strength, and ambulatory function were obtained. Of the 93 patients who met the entry criteria for the study, 71 completed the 3-year and 50 completed the 5-year assessments, respectively. Statistical analysis demonstrated significant improvements in spasticity, range of motion, and functional muscle strength at 1 year after SPR. The preoperative, 1-, 3-, and 5-year values for the global score of the Gross Motor Function Measure were 64.6, 70.8, 80, and 85.6, respectively. The greatest improvement occurred in the dimensions reflecting lower-extremity motor function, where the mean change was 10.1% at 1 year, 19.9% at 3 years, and 34.4% at the 5-year follow-up review in comparison with the baseline value. This was associated with a lasting improvement in alignment and postural stability during developmental positions, as well as increased ability to perform difficult transitional movements.

Conclusions. The results of this study support the presence of significant improvements in lower-limb functional motor outcome 1 year after SPR, and the improvements persist at 3 and 5 years. The authors conclude that SPR in conjunction with intraoperative stimulation is valuable for permanently alleviating lower-limb spasticity while augmenting motor function.

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  • 1.

    Abbott R: Complications with selective posterior rhizotomy. Pediatr Neurosurg 18:4347, 1992 Abbott R: Complications with selective posterior rhizotomy. Pediatr Neurosurg 18:43–47, 1992

    • Search Google Scholar
    • Export Citation
  • 2.

    Abbott R, , Johann-Murphy M, & Shiminski-Maher T, et al: Selective dorsal rhizotomy: outcome and complications in treating spastic cerebral palsy. Neurosurgery 33:851857, 1993 Abbott R, Johann-Murphy M, Shiminski-Maher T, et al: Selective dorsal rhizotomy: outcome and complications in treating spastic cerebral palsy. Neurosurgery 33:851–857, 1993

    • Search Google Scholar
    • Export Citation
  • 3.

    Adams J, , Cahan LD, & Perry J, et al: Foot contact pattern following selective dorsal rhizotomy. Pediatr Neurosurg 23:7681, 1995 Adams J, Cahan LD, Perry J, et al: Foot contact pattern following selective dorsal rhizotomy. Pediatr Neurosurg 23:76–81, 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Arens LJ, , Peacock WJ, & Peter J: Selective posterior rhizotomy: a long-term follow-up study. Childs Nerv Syst 5:148152, 1989 Arens LJ, Peacock WJ, Peter J: Selective posterior rhizotomy: a long-term follow-up study. Childs Nerv Syst 5:148–152, 1989

    • Search Google Scholar
    • Export Citation
  • 5.

    Bax MCO: Terminology and classification of cerebral palsy. Dev Med Child Neurol 6:295296, 1964 Bax MCO: Terminology and classification of cerebral palsy. Dev Med Child Neurol 6:295–296, 1964

    • Search Google Scholar
    • Export Citation
  • 6.

    Beck AJ, , Gaskill SJ, & Marlin AE: Improvement in upper extremity function and trunk control after selective posterior rhizotomy. Am J Occup Ther 47:704707, 1993 Beck AJ, Gaskill SJ, Marlin AE: Improvement in upper extremity function and trunk control after selective posterior rhizotomy. Am J Occup Ther 47:704–707, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Berman B, , Vaughan CL, & Peacock WJ: The effect of rhizotomy on movement in patients with cerebral palsy. Am J Occup Ther 44:511516, 1990 Berman B, Vaughan CL, Peacock WJ: The effect of rhizotomy on movement in patients with cerebral palsy. Am J Occup Ther 44:511–516, 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    Bloom KK, & Nazar GB: Functional assessment following selective posterior rhizotomy in spastic cerebral palsy. Childs Nerv Syst 10:8486, 1994 Bloom KK, Nazar GB: Functional assessment following selective posterior rhizotomy in spastic cerebral palsy. Childs Nerv Syst 10:84–86, 1994

    • Search Google Scholar
    • Export Citation
  • 9.

    Boscarino LF, , Ounpuu S, & Davis RBD III, et al: Effects of selective dorsal rhizotomy on gait in children with cerebral palsy. J Pediatr Orthop 13:174179, 1993 Boscarino LF, Ounpuu S, Davis RBD III, et al: Effects of selective dorsal rhizotomy on gait in children with cerebral palsy. J Pediatr Orthop 13:174–179, 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Buckon CE, , Sienko Thomas S, & Aiona MD, et al: Assessment of upper-extremity function in children with spastic diplegia before and after selective dorsal rhizotomy. Dev Med Child Neurol 38:967975, 1996 Buckon CE, Sienko Thomas S, Aiona MD, et al: Assessment of upper-extremity function in children with spastic diplegia before and after selective dorsal rhizotomy. Dev Med Child Neurol 38:967–975, 1996

    • Search Google Scholar
    • Export Citation
  • 11.

    Buckon CE, , Thomas S, & Pierce R, et al: Developmental skills of children with spastic diplegia: functional and qualitative changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 78:946951, 1997 Buckon CE, Thomas S, Pierce R, et al: Developmental skills of children with spastic diplegia: functional and qualitative changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 78:946–951, 1997

    • Search Google Scholar
    • Export Citation
  • 12.

    Cahan LD, , Adams JM, & Perry J, et al: Instrumented gait analysis after selective dorsal rhizotomy. Dev Med Child Neurol 32:10371043, 1990 Cahan LD, Adams JM, Perry J, et al: Instrumented gait analysis after selective dorsal rhizotomy. Dev Med Child Neurol 32:1037–1043, 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Chicoine MR, , Park TS, & Kaufman BA: Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. J Neurosurg 86:3439, 1997 Chicoine MR, Park TS, Kaufman BA: Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. J Neurosurg 86:34–39, 1997

    • Search Google Scholar
    • Export Citation
  • 14.

    Cohen AR, & Webster HC: How selective is selective posterior rhizotomy? Surg Neurol 35:267272, 1991 Cohen AR, Webster HC: How selective is selective posterior rhizotomy? Surg Neurol 35:267–272, 1991

    • Search Google Scholar
    • Export Citation
  • 15.

    Cosgrove AP, , Corry IS, & Graham HK: Botulinum toxin in the management of the lower limb in cerebral palsy. Dev Med Child Neurol 36:386396, 1994 Cosgrove AP, Corry IS, Graham HK: Botulinum toxin in the management of the lower limb in cerebral palsy. Dev Med Child Neurol 36:386–396, 1994

    • Search Google Scholar
    • Export Citation
  • 16.

    Deletis V, , Vodusek DB, & Abbott R, et al: Intraoperative monitoring of the dorsal sacral roots: minimizing the risk of iatrogenic micturition disorders. Neurosurgery 30:7275, 1992 Deletis V, Vodusek DB, Abbott R, et al: Intraoperative monitoring of the dorsal sacral roots: minimizing the risk of iatrogenic micturition disorders. Neurosurgery 30:72–75, 1992

    • Search Google Scholar
    • Export Citation
  • 17.

    Dudgeon BJ, , Libby AK, & McLaughlin JF, et al: Prospective measurement of functional changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 75:4653, 1994 Dudgeon BJ, Libby AK, McLaughlin JF, et al: Prospective measurement of functional changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 75:46–53, 1994

    • Search Google Scholar
    • Export Citation
  • 18.

    Engsberg JR, , Olree KS, & Ross SA, et al: Spasticity and strength changes as a function of selective dorsal rhizotomy. J Neurosurg 88:10201026, 1998 Engsberg JR, Olree KS, Ross SA, et al: Spasticity and strength changes as a function of selective dorsal rhizotomy. J Neurosurg 88:1020–1026, 1998

    • Search Google Scholar
    • Export Citation
  • 19.

    Engsberg JR, , Ross SA, & Park TS: Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy. J Neurosurg 91:727732, 1999 Engsberg JR, Ross SA, Park TS: Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy. J Neurosurg 91:727–732, 1999

    • Search Google Scholar
    • Export Citation
  • 20.

    Fasano VA, , Broggi G, & Barolat-Romana G, et al: Surgical treatment of spasticity in cerebral palsy. Childs Brain 4:289305, 1978 Fasano VA, Broggi G, Barolat-Romana G, et al: Surgical treatment of spasticity in cerebral palsy. Childs Brain 4:289–305, 1978

    • Search Google Scholar
    • Export Citation
  • 21.

    Fasano VA, , Broggi G, & Zeme S: Intraoperative electrical stimulation for functional posterior rhizotomy. Scand J Rehabil Med Suppl 17:149154, 1988 Fasano VA, Broggi G, Zeme S: Intraoperative electrical stimulation for functional posterior rhizotomy. Scand J Rehabil Med Suppl 17:149–154, 1988

    • Search Google Scholar
    • Export Citation
  • 22.

    Foerster O: On the indications and results of the excision of posterior spinal nerve roots in men. Surg Gynecol Obstet 16:463474, 1913 Foerster O: On the indications and results of the excision of posterior spinal nerve roots in men. Surg Gynecol Obstet 16:463–474, 1913

    • Search Google Scholar
    • Export Citation
  • 23.

    Fraioli B, & Guidetti B: Posterior partial rootlet section in the treatment of spasticity. J Neurosurg 46:618626, 1977 Fraioli B, Guidetti B: Posterior partial rootlet section in the treatment of spasticity. J Neurosurg 46:618–626, 1977

    • Search Google Scholar
    • Export Citation
  • 24.

    Fraioli B, , Zamponi C, & Baldassarre L, et al: Selective posterior rootlet section in the treatment of spastic disorders of infantile cerebral palsy: immediate and late results. Acta Neurochir Suppl 33:539541, 1984 Fraioli B, Zamponi C, Baldassarre L, et al: Selective posterior rootlet section in the treatment of spastic disorders of infantile cerebral palsy: immediate and late results. Acta Neurochir Suppl 33:539–541, 1984

    • Search Google Scholar
    • Export Citation
  • 25.

    Fukuhara T, , Najm IM, & Levin KH, et al: Nerve rootlets to be setioned for spasticity resolution in selective dorsal rhizotomy. Surg Neurol 54:126133, 2000 Fukuhara T, Najm IM, Levin KH, et al: Nerve rootlets to be setioned for spasticity resolution in selective dorsal rhizotomy. Surg Neurol 54:126–133, 2000

    • Search Google Scholar
    • Export Citation
  • 26.

    Gros C, , Ouaknine G, & Vlahovitch B, et al: La radicotomie sélective postérieure dans le traitement neuro-chirurgical de l'hypertonie pyramidale. Neurochirurgie 13:505518, 1967 Gros C, Ouaknine G, Vlahovitch B, et al: La radicotomie sélective postérieure dans le traitement neuro-chirurgical de l'hypertonie pyramidale. Neurochirurgie 13:505–518, 1967

    • Search Google Scholar
    • Export Citation
  • 27.

    Gul SM, , Steinbok P, & McLeod K: Long-term outcome after selective posterior rhizotomy in children with spastic cerebral palsy. Pediatr Neurosurg 31:8495, 1999 Gul SM, Steinbok P, McLeod K: Long-term outcome after selective posterior rhizotomy in children with spastic cerebral palsy. Pediatr Neurosurg 31:84–95, 1999

    • Search Google Scholar
    • Export Citation
  • 28.

    Hays RM, , McLaughlin JF, & Bjornson KF, et al: Electrophysiological monitoring during selective dorsal rhizotomy, and spasticity and GMFM performance. Dev Med Child Neurol 40:233238, 1998 Hays RM, McLaughlin JF, Bjornson KF, et al: Electrophysiological monitoring during selective dorsal rhizotomy, and spasticity and GMFM performance. Dev Med Child Neurol 40:233–238, 1998

    • Search Google Scholar
    • Export Citation
  • 29.

    Heim RC, , Park TS, & Vogler GP, et al: Changes in hip migration after selective dorsal rhizotomy for spastic quadriplegia in cerebral palsy. J Neurosurg 82:567571, 1995 Heim RC, Park TS, Vogler GP, et al: Changes in hip migration after selective dorsal rhizotomy for spastic quadriplegia in cerebral palsy. J Neurosurg 82:567–571, 1995

    • Search Google Scholar
    • Export Citation
  • 30.

    Hodgkinson I, , Bérard C, & Jindrich ML, et al: Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively. Stereotact Funct Neurosurg 69:259267, 1997 Hodgkinson I, Bérard C, Jindrich ML, et al: Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively. Stereotact Funct Neurosurg 69:259–267, 1997

    • Search Google Scholar
    • Export Citation
  • 31.

    Houle AM, , Vernet O, & Jednak R, et al: Bladder function before and after selective dorsal rhizotomy in children with cerebral palsy. J Urol 160:10881091, 1998 Houle AM, Vernet O, Jednak R, et al: Bladder function before and after selective dorsal rhizotomy in children with cerebral palsy. J Urol 160:1088–1091, 1998

    • Search Google Scholar
    • Export Citation
  • 32.

    Johann-Murphy M, , Bier TC, & Shakin R, et al: Reliability of the New York University rhizotomy evaluation form. Pediatr Phys Ther 5:6974, 1993 Johann-Murphy M, Bier TC, Shakin R, et al: Reliability of the New York University rhizotomy evaluation form. Pediatr Phys Ther 5:69–74, 1993

    • Search Google Scholar
    • Export Citation
  • 33.

    Lazareff JA, , Garcia-Mendez MA, & De Rosa R, et al: Limited (L4-s1, L5-s1) selective dorsal rhizotomy for reducing spasticity in cerebral palsy. Acta Neurochir 141:743752, 1999 Lazareff JA, Garcia-Mendez MA, De Rosa R, et al: Limited (L4-s1, L5-s1) selective dorsal rhizotomy for reducing spasticity in cerebral palsy. Acta Neurochir 141:743–752, 1999

    • Search Google Scholar
    • Export Citation
  • 34.

    Lazareff JA, , Mata-Acosta AM, & Garcia-Mendez MA: Limited selective posterior rhizotomy for the treatment of spasticity secondary to infantile cerebral palsy: a preliminary report. Neurosurgery 27:535538, 1990 Lazareff JA, Mata-Acosta AM, Garcia-Mendez MA: Limited selective posterior rhizotomy for the treatment of spasticity secondary to infantile cerebral palsy: a preliminary report. Neurosurgery 27:535–538, 1990

    • Search Google Scholar
    • Export Citation
  • 35.

    Loewen P, , Steinbok P, & Holsti L, et al: Upper extremity performance and self-care skill changes in children with spastic cerebral palsy following selective posterior rhizotomy. Pediatr Neurosurg 29:191198, 1998 Loewen P, Steinbok P, Holsti L, et al: Upper extremity performance and self-care skill changes in children with spastic cerebral palsy following selective posterior rhizotomy. Pediatr Neurosurg 29:191–198, 1998

    • Search Google Scholar
    • Export Citation
  • 36.

    Logigian EL, , Shefner JM, & Goumnerova L, et al: The critical importance of stimulus intensity in intraoperative monitoring for partial dorsal rhizotomy. Muscle Nerve 19:415422, 1996 Logigian EL, Shefner JM, Goumnerova L, et al: The critical importance of stimulus intensity in intraoperative monitoring for partial dorsal rhizotomy. Muscle Nerve 19:415–422, 1996

    • Search Google Scholar
    • Export Citation
  • 37.

    Marty GR, , Dias LS, & Gaebler-Spira D: Selective posterior rhizotomy and soft-tissue procedures for the treatment of cerebral diplegia. J Bone Joint Surg Am 77:713718, 1995 Marty GR, Dias LS, Gaebler-Spira D: Selective posterior rhizotomy and soft-tissue procedures for the treatment of cerebral diplegia. J Bone Joint Surg Am 77:713–718, 1995

    • Search Google Scholar
    • Export Citation
  • 38.

    McLaughlin JF, , Bjornson KF, & Astley SJ, et al: The role of selective dorsal rhizotomy in cerebral palsy: critical evaluation of a prospective clinical series. Dev Med Child Neurol 36:755769, 1994 McLaughlin JF, Bjornson KF, Astley SJ, et al: The role of selective dorsal rhizotomy in cerebral palsy: critical evaluation of a prospective clinical series. Dev Med Child Neurol 36:755–769, 1994

    • Search Google Scholar
    • Export Citation
  • 39.

    McLaughlin JF, , Bjornson KF, & Astley SJ, et al: Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40:220232, 1998 McLaughlin JF, Bjornson KF, Astley SJ, et al: Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40:220–232, 1998

    • Search Google Scholar
    • Export Citation
  • 40.

    Mittal S, , Farmer JP, & Poulin C, et al: Reliability of intraoperative electrophysiological monitoring in selective posterior rhizotomy. J Neurosurg 95:6775, 2001 Mittal S, Farmer JP, Poulin C, et al: Reliability of intraoperative electrophysiological monitoring in selective posterior rhizotomy. J Neurosurg 95:67–75, 2001

    • Search Google Scholar
    • Export Citation
  • 41.

    Montgomery PC: A clinical report of long term outcomes following selective posterior rhizotomy: implications for selection, follow-up, and research. Phys Occup Ther Pediatr 12:6987, 1992 Montgomery PC: A clinical report of long term outcomes following selective posterior rhizotomy: implications for selection, follow-up, and research. Phys Occup Ther Pediatr 12:69–87, 1992

    • Search Google Scholar
    • Export Citation
  • 42.

    Newberg NL, , Gooch JL, & Walker ML: Intraoperative monitoring in selective dorsal rhizotomy. Pediatr Neurosurg 17:124127, 1991/1992 Newberg NL, Gooch JL, Walker ML: Intraoperative monitoring in selective dorsal rhizotomy. Pediatr Neurosurg 17:124–127, 1991/1992

    • Search Google Scholar
    • Export Citation
  • 43.

    Nishida T, , Thatcher SW, & Marty GR: Selective posterior rhizotomy for children with cerebral palsy: a 7-year experience. Childs Nerv Syst 11:374380, 1995 Nishida T, Thatcher SW, Marty GR: Selective posterior rhizotomy for children with cerebral palsy: a 7-year experience. Childs Nerv Syst 11:374–380, 1995

    • Search Google Scholar
    • Export Citation
  • 44.

    Park TS, , Vogler GP, & Phillips LH II, et al: Effects of selective dorsal rhizotomy for spastic diplegia on hip migration in cerebral palsy. Pediatr Neurosurg 20:4349, 1994 Park TS, Vogler GP, Phillips LH II, et al: Effects of selective dorsal rhizotomy for spastic diplegia on hip migration in cerebral palsy. Pediatr Neurosurg 20:43–49, 1994

    • Search Google Scholar
    • Export Citation
  • 45.

    Peacock WJ, & Arens LJ: Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J 62:119124, 1982 Peacock WJ, Arens LJ: Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J 62:119–124, 1982

    • Search Google Scholar
    • Export Citation
  • 46.

    Peacock WJ, , Arens LJ, & Berman B: Cerebral palsy spasticity. Selective posterior rhizotomy. Pediatr Neurosci 13:6166, 1987 Peacock WJ, Arens LJ, Berman B: Cerebral palsy spasticity. Selective posterior rhizotomy. Pediatr Neurosci 13:61–66, 1987

    • Search Google Scholar
    • Export Citation
  • 47.

    Peacock WJ, , Nuwer MR, & Staudt LA: Dorsal rhizotomy: to monitor or not to monitor. J Neurosurg 80:769772, 1994 (Letter) Peacock WJ, Nuwer MR, Staudt LA: Dorsal rhizotomy: to monitor or not to monitor. J Neurosurg 80:769–772, 1994 (Letter)

    • Search Google Scholar
    • Export Citation
  • 48.

    Peacock WJ, & Staudt LA: Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg 74:380385, 1991 Peacock WJ, Staudt LA: Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg 74:380–385, 1991

    • Search Google Scholar
    • Export Citation
  • 49.

    Peter JC, & Arens LJ: Selective posterior lumbosacral rhizotomy for the management of cerebral palsy spasticity. A 10-year experience. S Afr Med J 83:745747, 1993 Peter JC, Arens LJ: Selective posterior lumbosacral rhizotomy for the management of cerebral palsy spasticity. A 10-year experience. S Afr Med J 83:745–747, 1993

    • Search Google Scholar
    • Export Citation
  • 50.

    Peter JC, & Arens LJ: Selective posterior lumbosacral rhizotomy in teenagers and young adults with spastic cerebral palsy. Br J Neurosurg 8:135139, 1994 Peter JC, Arens LJ: Selective posterior lumbosacral rhizotomy in teenagers and young adults with spastic cerebral palsy. Br J Neurosurg 8:135–139, 1994

    • Search Google Scholar
    • Export Citation
  • 51.

    Pollack MA: Limited benefit of electrophysiological studies during dorsal rhizotomy. Muscle Nerve 17:553555, 1994 Pollack MA: Limited benefit of electrophysiological studies during dorsal rhizotomy. Muscle Nerve 17:553–555, 1994

    • Search Google Scholar
    • Export Citation
  • 52.

    Russell DJ, , Rosenbaum PL, & Cadman DT, et al: The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 31:341352, 1989 Russell DJ, Rosenbaum PL, Cadman DT, et al: The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 31:341–352, 1989

    • Search Google Scholar
    • Export Citation
  • 53.

    Sacco DJ, , Tylkowski CM, & Warf BC: Nonselective partial dorsal rhizotomy: a clinical experience with 1-year follow-up. Pediatr Neurosurg 32:114118, 2000 Sacco DJ, Tylkowski CM, Warf BC: Nonselective partial dorsal rhizotomy: a clinical experience with 1-year follow-up. Pediatr Neurosurg 32:114–118, 2000

    • Search Google Scholar
    • Export Citation
  • 54.

    Schijman E, , Erro MG, & Meana NV: Selective posterior rhizotomy: experience of 30 cases. Childs Nerv Syst 9:474477, 1993 Schijman E, Erro MG, Meana NV: Selective posterior rhizotomy: experience of 30 cases. Childs Nerv Syst 9:474–477, 1993

    • Search Google Scholar
    • Export Citation
  • 55.

    Siegfried J, , Lazorthes Y, & Broggi G, et al: La neurochirurgie functionnelle de l'infirmite motrice d'origine. Neurochirurgie 31 (Suppl 1):1118, 1985 Siegfried J, Lazorthes Y, Broggi G, et al: La neurochirurgie functionnelle de l'infirmite motrice d'origine. Neurochirurgie 31 (Suppl 1):1–118, 1985

    • Search Google Scholar
    • Export Citation
  • 56.

    Staudt LA, , Nuwer MR, & Peacock WJ: Intraoperative monitoring during selective posterior rhizotomy: technique and patient outcome. Electroencephalogr Clin Neurophysiol 97:296309, 1995 Staudt LA, Nuwer MR, Peacock WJ: Intraoperative monitoring during selective posterior rhizotomy: technique and patient outcome. Electroencephalogr Clin Neurophysiol 97:296–309, 1995

    • Search Google Scholar
    • Export Citation
  • 57.

    Steinbok P: Outcomes after selective dorsal rhizotomy for spastic cerebral palsy. Childs Nerv Syst 17:118, 2001 Steinbok P: Outcomes after selective dorsal rhizotomy for spastic cerebral palsy. Childs Nerv Syst 17:1–18, 2001

    • Search Google Scholar
    • Export Citation
  • 58.

    Steinbok P, , Gustavsson B, & Kestle JR, et al: Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy. J Neurosurg 83:1826, 1995 Steinbok P, Gustavsson B, Kestle JR, et al: Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy. J Neurosurg 83:18–26, 1995

    • Search Google Scholar
    • Export Citation
  • 59.

    Steinbok P, & Kestle JR: Variation between centers in electrophysiologic techniques used in lumbosacral selective dorsal rhizotomy for spastic cerebral palsy. Pediatr Neurosurg 25:233239, 1996 Steinbok P, Kestle JR: Variation between centers in electrophysiologic techniques used in lumbosacral selective dorsal rhizotomy for spastic cerebral palsy. Pediatr Neurosurg 25:233–239, 1996

    • Search Google Scholar
    • Export Citation
  • 60.

    Steinbok P, , Keyes R, & Langill L, et al: The validity of electrophysiological criteria used in selective functional posterior rhizotomy for treatment of spastic cerebral palsy. J Neurosurg 81:354361, 1994 Steinbok P, Keyes R, Langill L, et al: The validity of electrophysiological criteria used in selective functional posterior rhizotomy for treatment of spastic cerebral palsy. J Neurosurg 81:354–361, 1994

    • Search Google Scholar
    • Export Citation
  • 61.

    Steinbok P, , Reiner A, & Beauchamp RD, et al: Selective functional posterior rhizotomy for treatment of spastic cerebral palsy in children. Review of 50 consecutive cases. Pediatr Neurosurg 18:3442, 1992 Steinbok P, Reiner A, Beauchamp RD, et al: Selective functional posterior rhizotomy for treatment of spastic cerebral palsy in children. Review of 50 consecutive cases. Pediatr Neurosurg 18:34–42, 1992

    • Search Google Scholar
    • Export Citation
  • 62.

    Steinbok P, , Reiner AM, & Beauchamp R, et al: A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39:178184, 1997 Steinbok P, Reiner AM, Beauchamp R, et al: A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39:178–184, 1997

    • Search Google Scholar
    • Export Citation
  • 63.

    Steinbok P, & Schrag C: Complications after selective posterior rhizotomy for spasticity in children with cerebral palsy. Pediatr Neurosurg 28:300313, 1998 Steinbok P, Schrag C: Complications after selective posterior rhizotomy for spasticity in children with cerebral palsy. Pediatr Neurosurg 28:300–313, 1998

    • Search Google Scholar
    • Export Citation
  • 64.

    Storrs BB, & Nishida T: Use of the ‘H’ reflex recovery curve in selective posterior rhizotomy. Pediatr Neurosci 14:120123, 1988 Storrs BB, Nishida T: Use of the ‘H’ reflex recovery curve in selective posterior rhizotomy. Pediatr Neurosci 14:120–123, 1988

    • Search Google Scholar
    • Export Citation
  • 65.

    Subramanian N, , Vaughan CL, & Peter JC, et al: Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity. J Neurosurg 88:10141019, 1998 Subramanian N, Vaughan CL, Peter JC, et al: Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity. J Neurosurg 88:1014–1019, 1998

    • Search Google Scholar
    • Export Citation
  • 66.

    Thomas SS, , Aiona MD, & Pierce R, et al: Gait changes in children with spastic diplegia after selective dorsal rhizotomy. J Pediatr Orthop 16:747752, 1996 Thomas SS, Aiona MD, Pierce R, et al: Gait changes in children with spastic diplegia after selective dorsal rhizotomy. J Pediatr Orthop 16:747–752, 1996

    • Search Google Scholar
    • Export Citation
  • 67.

    Ubhi T, , Bhakta BB, & Ives HL, et al: Randomised double blind placebo controlled trial to the effect of botulinum toxin on walking in cerebral palsy. Arch Dis Child 83:481487, 2000 Ubhi T, Bhakta BB, Ives HL, et al: Randomised double blind placebo controlled trial to the effect of botulinum toxin on walking in cerebral palsy. Arch Dis Child 83:481–487, 2000

    • Search Google Scholar
    • Export Citation
  • 68.

    Vaughan CL, , Berman B, & Peacock WJ: Cerebral palsy and rhizotomy. A 3-year follow-up evaluation with gait analysis. J Neurosurg 74:178184, 1991 Vaughan CL, Berman B, Peacock WJ: Cerebral palsy and rhizotomy. A 3-year follow-up evaluation with gait analysis. J Neurosurg 74:178–184, 1991

    • Search Google Scholar
    • Export Citation
  • 69.

    Vaughan CL, , Berman B, & Staudt LA, et al: Gait analysis of cerebral palsy children before and after rhizotomy. Pediatr Neurosci 14:297300, 1988 Vaughan CL, Berman B, Staudt LA, et al: Gait analysis of cerebral palsy children before and after rhizotomy. Pediatr Neurosci 14:297–300, 1988

    • Search Google Scholar
    • Export Citation
  • 70.

    Warf BC, & Nelson KR: The electromyographic responses to dorsal rootlet stimulation during partial dorsal rhizotomy are inconsistent. Pediatr Neurosurg 25:1319, 1996 Warf BC, Nelson KR: The electromyographic responses to dorsal rootlet stimulation during partial dorsal rhizotomy are inconsistent. Pediatr Neurosurg 25:13–19, 1996

    • Search Google Scholar
    • Export Citation
  • 71.

    Weiss IP, & Schiff SJ: Reflex variability in selective dorsal rhizotomy. J Neurosurg 79:346353, 1993 Weiss IP, Schiff SJ: Reflex variability in selective dorsal rhizotomy. J Neurosurg 79:346–353, 1993

    • Search Google Scholar
    • Export Citation
  • 72.

    Wong AM, , Chen CL, & Hong WH, et al: Motor control assessment for rhizotomy in cerebral palsy. Am J Phys Med Rehabil 79:441450, 2000 Wong AM, Chen CL, Hong WH, et al: Motor control assessment for rhizotomy in cerebral palsy. Am J Phys Med Rehabil 79:441–450, 2000

    • Search Google Scholar
    • Export Citation
  • 73.

    Wright FV, , Sheil EM, & Drake JM, et al: Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 40:239247, 1998 Wright FV, Sheil EM, Drake JM, et al: Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 40:239–247, 1998

    • Search Google Scholar
    • Export Citation
  • 74.

    Yang TF, , Chan RC, & Wong TT, et al: Quantitative measurement of improvement in sitting balance in children with spastic cerebral palsy after selective posterior rhizotomy. Am J Phys Med Rehabil 75:348352, 1996 Yang TF, Chan RC, Wong TT, et al: Quantitative measurement of improvement in sitting balance in children with spastic cerebral palsy after selective posterior rhizotomy. Am J Phys Med Rehabil 75:348–352, 1996

    • Search Google Scholar
    • Export Citation

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