Skip to main content

Advertisement

SpringerLink
Log in

Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to evaluate long-term outcomes after selective dorsal rhizotomy (SDR) for children with spastic cerebral palsy.

Methods

This is a retrospective review of a prospective database of patients who underwent SDR at British Columbia Children’s Hospital. Hip adductor spasticity, hip range of motion (ROM), quadriceps strength, and motor function were assessed pre-operatively, at 6 months to 5 years and more than 10 years postoperatively. Patients were stratified by Gross Motor Function Classification System (GMFCS) level into group 1 (GMFCS II and III) and group 2 (GMFCS IV and V).

Results

Forty-four patients, with mean age at SDR of 4.5 years (range 2.9–7.7), were followed for a mean 14.4 years. Spasticity (Modified Ashworth Scale) decreased 1.5 (p < 0.0001) by early postoperative evaluation with further decrease at late evaluation of 0.8 (p < 0.0001). Early improvement in hip ROM of 13.7 degrees (p < 0.0001) was not sustained at late assessment. Motor function improved in both groups at early assessment but was only sustained in group 1. Group 1 increased 10.0 points (p < 0.0001) at early evaluation with subsequent decrease of 3.5, resulting in an overall increase of 6.6 (p = 0.04) from baseline. Group 2 patients had an initial increase of 8.3 [2.0, 14.6] (p = 0.01) but then declined to 4.9 below baseline (p = 0.3).

Conclusions

SDR yields durable reduction in spasticity after 10 years. Early improvements in motor function are present, but at long-term follow-up, these improvements were attenuated in GMFCS II and III and were not sustained in GMFCS IV and V.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Mittal S, Farmer JP, Al-Atassi B, Gibis J, Kennedy E, Galli C, Courchesnes G, Poulin C, Cantin MA, Benaroch TE (2002) Long-term functional outcome after selective posterior rhizotomy. J Neurosurg 97:315–325

    Article  PubMed  Google Scholar 

  4. Mittal S, Farmer JP, Al-Atassi B, Montpetit K, Gervais N, Poulin C, Benaroch TE, Cantin MA (2002) Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure. J Neurosurg 97:510–518

    Article  PubMed  Google Scholar 

  5. Grunt S, Becher JG, Vermeulen RJ (2011) Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. Dev Med Child Neurol 53:490–498

    Article  PubMed  Google Scholar 

  6. Langerak NG, Hillier SL, Verkoeijen PP, Peter JC, Fieggen AG, Vaughan CL (2011) Level of activity and participation in adults with spastic diplegia 17-26 years after selective dorsal rhizotomy. J Rehabil Med 43:330–337

    Article  PubMed  Google Scholar 

  7. Langerak NG, Lamberts RP, Fieggen AG, Peter JC, Peacock WJ, Vaughan CL (2007) Selective dorsal rhizotomy: long-term experience from Cape Town. Childs Nerv Syst 23:1003–1006

    Article  PubMed  Google Scholar 

  8. Langerak NG, Lamberts RP, Fieggen AG, Peter JC, Peacock WJ, Vaughan CL (2009) Functional status of patients with cerebral palsy according to the International Classification of Functioning, Disability and Health model: a 20-year follow-up study after selective dorsal rhizotomy. Arch Phys Med Rehabil 90:994–1003

    Article  PubMed  Google Scholar 

  9. Langerak NG, Lamberts RP, Fieggen AG, Peter JC, van der Merwe L, Peacock WJ, Vaughan CL (2008) A prospective gait analysis study in patients with diplegic cerebral palsy 20 years after selective dorsal rhizotomy. J Neurosurg Pediatr 1:180–186

    Article  PubMed  Google Scholar 

  10. Langerak NG, Tam N, Vaughan CL, Fieggen AG, Schwartz MH (2012) Gait status 17–26 years after selective dorsal rhizotomy. Gait Posture 35:244–249

    Article  PubMed  Google Scholar 

  11. Langerak NG, Vaughan CL, Hoffman EB, Figaji AA, Fieggen AG, Peter JC (2009) Incidence of spinal abnormalities in patients with spastic diplegia 17 to 26 years after selective dorsal rhizotomy. Childs Nerv Syst 25:1593–1603

    Article  PubMed  Google Scholar 

  12. Bolster EA, van Schie PE, Becher JG, van Ouwerkerk WJ, Strijers RL, Vermeulen RJ (2013) Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Dev Med Child Neurol 55:610–616

    Article  PubMed  Google Scholar 

  13. Dudley RW, Parolin M, Gagnon B, Saluja R, Yap R, Montpetit K, Ruck J, Poulin C, Cantin MA, Benaroch TE, Farmer JP (2013) Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatr 12:142–150

    Article  PubMed  Google Scholar 

  14. Tedroff K, Lowing K, Jacobson DN, Astrom E (2011) Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy. Dev Med Child Neurol 53:724–729

    Article  PubMed  Google Scholar 

  15. Hurvitz EA, Marciniak CM, Daunter AK, Haapala HJ, Stibb SM, McCormick SF, Muraszko KM, Gaebler-Spira D (2013) Functional outcomes of childhood dorsal rhizotomy in adults and adolescents with cerebral palsy. J Neurosurg Pediatr 11:380–388

    Article  PubMed  Google Scholar 

  16. Bohannon RW, Smith MB (1987) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67:206–207

    CAS  PubMed  Google Scholar 

  17. Gajdosik RL, Bohannon RW (1987) Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Phys Ther 67:1867–1872

    CAS  PubMed  Google Scholar 

  18. McLaughlin JF, Bjornson KF, Astley SJ, Hays RM, Hoffinger SA, Armantrout EA, Roberts TS (1994) The role of selective dorsal rhizotomy in cerebral palsy: critical evaluation of a prospective clinical series. Dev Med Child Neurol 36:755–769

    Article  CAS  PubMed  Google Scholar 

  19. Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S (1989) The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 31:341–352

    Article  CAS  PubMed  Google Scholar 

  20. Steinbok P, Tidemann AJ, Miller S, Mortenson P, Bowen-Roberts T (2009) Electrophysiologically guided versus non-electrophysiologically guided selective dorsal rhizotomy for spastic cerebral palsy: a comparison of outcomes. Childs Nerv Syst 25:1091–1096

    Article  PubMed  Google Scholar 

  21. Hanna SE, Rosenbaum PL, Bartlett DJ, Palisano RJ, Walter SD, Avery L, Russell DJ (2009) Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol 51:295–302

    Article  PubMed  Google Scholar 

  22. Grunt S, Fieggen AG, Vermeulen RJ, Becher JG, Langerak NG (2014) Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature. Dev Med Child Neurol 56:302–312

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Nothing to disclose.

Author information

Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and British Columbia Children’s Hospital, 4480 Oak St., Room K3-159, Vancouver, BC, V6H 3V4, Canada

    Tamir Ailon, John M. Kerr, Alexander R. Hengel & Paul Steinbok

  2. Division of Orthopedic Surgery, Department of Surgery, University of British Columbia and British Columbia Children’s Hospital, Vancouver, BC, Canada

    Richard Beauchamp

  3. Division of Physiotherapy, British Columbia Children’s Hospital, Vancouver, BC, Canada

    Stacey Miller

  4. Division of Occupational Therapy, University of British Columbia and British Columbia Children’s Hospital, Vancouver, BC, Canada

    Patricia Mortenson

Authors
  1. Tamir Ailon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Beauchamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stacey Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patricia Mortenson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John M. Kerr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexander R. Hengel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul Steinbok
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul Steinbok.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ailon, T., Beauchamp, R., Miller, S. et al. Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy. Childs Nerv Syst 31, 415–423 (2015). https://doi.org/10.1007/s00381-015-2614-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-015-2614-9

Keywords

Search

Navigation