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Published on: September 1, 2011
Motor function after selective dorsal rhizotomy: a 10-year practice-based follow-up study
Annika Lundkvist Josenby1, Philippe Wagner, Gun-Britt Jarnlo
1Division of Physiotherapy, Department of Health Sciences, Health Sciences Centre, Lund University, Lund, Sweden. annika.lundkvist@med.lu.se
Insights
Selective dorsal rhizotomy (SDR) improved motor function in children with spastic diplegia for up to 10 years. This surgical intervention, combined with physiotherapy, led to significant long-term gains in gross motor function.
Area of Science:
- Pediatric Orthopedics
- Neuroscience
- Rehabilitation Medicine
Background:
- Bilateral spastic diplegia is a common motor disorder in children.
- Selective dorsal rhizotomy (SDR) is a surgical procedure aimed at reducing spasticity.
- Long-term outcomes of SDR on motor function require further investigation.
Purpose of the Study:
- To evaluate changes in motor function up to 10 years following selective dorsal rhizotomy (SDR) in children with bilateral spastic diplegia.
- To assess the long-term effects of SDR on muscle tone, range of motion, and gross motor function.
Main Methods:
- A cohort of 29 children with bilateral spastic diplegia underwent SDR at a median age of 4.3 years and were followed until a median age of 15 years.
- Assessments included muscle tone (modified Ashworth scale), passive range of motion (goniometry), and gross motor function (Gross Motor Function Measure-66, GMFM-66).
- Outcomes were compared to preoperative values, considering preoperative Gross Motor Function Classification System (GMFCS) levels.
Main Results:
- After 10 years, muscle tone normalized in a significant proportion of participants for hip flexors, adductors, knee flexors, and plantar flexors.
- Mean passive range of motion showed improvements, and the mean increase in GMFM-66 was 10.6 points.
- Improvements in GMFM-66 were correlated with preoperative GMFCS level and GMFM-66 scores.
Conclusions:
- SDR, when combined with physiotherapy and regular follow-up, leads to sustained improvements in gross motor function in children with spastic diplegia.
- The positive effects of SDR on motor function can last for at least 10 years postoperatively.
- Preoperative functional classification influences the degree of motor function improvement after SDR.
Aim:
The aim of this study was to explore changes in motor function up to 10 years after selective dorsal rhizotomy (SDR).
Method:
The participants comprised 29 children (20 males, nine females) with bilateral spastic diplegia who were consecutively operated on at a median age of 4 years and 3 months and followed until a median age of 15 years. SDR was combined with physiotherapy and regular follow-up visits. The distribution of preoperative Gross Motor Function Classification System (GMFCS) levels was as follows: I, n=1; II, n=7; III, n=8; IV, n=12; and V, n=1. Muscle tone in hip flexors, hip adductors, knee flexors, and plantar flexors was assessed with the modified Ashworth scale, passive range of motion in hip abduction, popliteal angle, maximum knee extension, dorsiflexion of the foot was measured with a goniometer, and gross motor function was assessed using the Gross Motor Function Measure (GMFM-66). The results were compared with preoperative values, taking into account age at the time of SDR.
Results:
After 10 years, muscle tone in hip flexors, hip adductors, knee flexors and plantar flexors was normalized in 19, 24, 13 and 23 participants respectively; mean change in passive range of motion ranged from -2.0° to 8.6°, and the mean increase in GMFM-66 was 10.6. Changes in GMFM-66 were associated with preoperative GMFCS level and GMFM-66 scores.
Interpretation:
Children who underwent SDR and physiotherapy and were regularly followed up by an experienced team showed improved gross motor function for up to 10 years postoperatively.
