Related Experiment Video
Updated: Jul 11, 2026
3D Printing Model of a Patient's Specific Lumbar Vertebra
Published on: April 14, 2023
Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience
G F Cole1, S E Farmer, A Roberts
1ORLAU, RJAH Orthopaedic Hospital, Oswestry, Shropshire, UK.
Insights
Strict patient selection for selective dorsal rhizotomy (SDR) in children with cerebral palsy significantly improves gait function and clinical outcomes, as confirmed by detailed gait analysis.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Selective Dorsal Rhizotomy (SDR) is known to reduce spasticity in children with cerebral palsy.
- Previous studies and meta-analyses indicate limited functional benefits despite spasticity reduction.
Purpose of the Study:
- To evaluate if stringent patient selection criteria enhance outcomes after SDR.
- To utilize gait analysis as a primary outcome measure for assessing functional improvement.
Main Methods:
- Ambulant children with cerebral palsy were selected using strict clinical criteria for SDR.
- Instrumented gait analysis was employed as the main outcome measure.
- Retrospective application of the Gross Motor Function Classification System (GMFCS) was used for functional assessment.
Main Results:
- Only 35% of referred children met the strict selection criteria.
- Post-SDR, significant improvements were observed in gait cosmesis, clinical examination, and gait parameters (temporal, kinetic, kinematic).
- Patients showed increased walking speed (0.15 m/s), step length (0.11 m), and improved knee extension and flexibility; 15 of 19 children improved by at least one GMFCS level.
Conclusions:
- Applying strict selection criteria for SDR in children with cerebral palsy yields encouraging functional improvements.
- Gait analysis provides objective evidence of enhanced outcomes post-SDR with rigorous patient selection.
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 degrees improvement in stance phase knee extension. Knees also became less stiff, with an 82 degrees /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.
