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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

Developmental Medicine and Child Neurology
|March 23, 2012
PubMed
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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).

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  • 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.