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Hip joint subluxation after selective dorsal rhizotomy for spastic cerebral palsy
Tufan Hicdonmez1, Paul Steinbok, Richard Beauchamp
1Division of Pediatric Neurosurgery, Department of Surgery, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada.
Insights
Selective dorsal rhizotomy (SDR) for spastic cerebral palsy (CP) rarely worsens hip subluxation. Higher Gross Motor Function Classification System (GMFCS) levels may increase the risk of hip subluxation worsening after SDR.
Area of Science:
- Orthopedic surgery
- Pediatric neurology
- Rehabilitation medicine
Background:
- Hip subluxation is a concern in children with spastic cerebral palsy (CP).
- The impact of selective dorsal rhizotomy (SDR) on hip joint stability in CP is not well-documented.
- Understanding these effects is crucial for surgical decision-making and patient management.
Purpose of the Study:
- To determine the incidence of hip subluxation following SDR in children with CP.
- To analyze factors influencing hip joint changes after SDR.
- To provide data on the safety of SDR concerning hip joint health.
Main Methods:
- Retrospective review of 82 children (164 hips) who underwent SDR for CP.
- Analysis of pre- and postoperative hip radiographs, measuring the center edge (CE) angle.
- Correlation of hip changes with preoperative variables, including GMFCS level.
Main Results:
- Most hips (43.5%) showed no significant change in CE angle post-SDR; 38.4% improved, and 17.7% worsened.
- The mean CE angle improved postoperatively for both right and left hips.
- Higher GMFCS levels were associated with a greater likelihood of hip subluxation worsening.
Conclusions:
- SDR has a predominantly positive or neutral effect on hip subluxation in children with CP.
- Worsening hip subluxation after SDR is more likely in patients with more severe motor impairment (higher GMFCS levels).
- SDR appears to be a relatively safe procedure regarding hip joint stability, with GMFCS as a key predictive factor.
Object:
The effects of selective dorsal rhizotomy (SDR) procedures on the hip joints of children with spastic cerebral palsy (CP) are not well described. This study was performed to determine the incidence of hip subluxation in children with CP who underwent SDR at a single institution.
Methods:
The study group comprised 82 patients (164 hip joints) with a mean follow up of 3.9 years. Forty-four patients had spastic diplegia (53.6%), 35 had spastic quadriplegia (42.7%), two had spastic triplegia (2.4%), and one had spastic hemiplegia (1.2%). The mean patient age at SDR was 5.2 +/- 2.4 years. Preoperative and postoperative hip radiographs were reviewed and the femoral head center edge (CE) angles were recorded. The mean pre- and postoperative right CE angles were 14.1 and 17.2 degrees, respectively, and those of the left were 13.6 and 15.1 degrees, respectively. Considering a change in CE angle greater than 5 degrees as clinically significant, 72 hips (43.5%) remained unchanged, 63 (38.4%) improved, and 29 (17.7%) worsened. Of a number of preoperative variables, including age at time of surgery, Gross Motor Function Classification System (GMFCS) level, ambulatory status, extent of hip subluxation, preoperative scoliosis, and asymmetry of hip subluxation, only GMFCS level was associated with worsening of hip subluxation.
Conclusions:
Selective dorsal rhizotomy is more likely to have a positive effect or no effect on hip joint subluxation rather than to have a negative effect. More severe involvement, as measured using the GMFCS, may predispose to worsening of hip subluxation after SDR.