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Factors Associated With Long-Term Improvement of Gait After Selective Dorsal Rhizotomy

Laura M Oudenhoven1, Marjolein M van der Krogt1, Marianna Romei1

  • 1Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.

Archives of Physical Medicine and Rehabilitation
|July 8, 2018
PubMed

Insights

Functional mobility and baseline gait quality predict long-term gait improvement in children after selective dorsal rhizotomy (SDR). Careful patient selection ensures SDR success for spastic diplegia.

Area of Science:

  • Pediatric Orthopedics
  • Neurorehabilitation
  • Movement Science

Background:

  • Selective dorsal rhizotomy (SDR) is a surgical procedure used to treat spasticity in children.
  • Gait impairment is a significant challenge for children with spastic diplegia, impacting their functional mobility.
  • Predicting long-term outcomes after SDR is crucial for optimizing patient selection and management.

Purpose of the Study:

  • To identify factors associated with long-term gait improvement in children following selective dorsal rhizotomy (SDR).
  • To evaluate the influence of baseline functional mobility and gait quality on post-SDR outcomes.

Main Methods:

  • Retrospective cohort study of 36 children (age 4-13) with spastic diplegia (GMFCS levels I-III) who underwent SDR.
  • Clinical gait analysis (Edinburgh Visual Gait Score - EVGS) was performed before and 5 years after SDR.
  • Factors analyzed included Gross Motor Function Classification System (GMFCS) level, brain MRI findings, and selective motor control.

Main Results:

  • Overall gait quality improved significantly after SDR, with considerable individual variability.
  • Worse baseline EVGS scores and higher GMFCS levels were independently associated with greater gait improvement.
  • Gait improvement was more pronounced in children with GMFCS levels I and II compared to level III.
  • Brain MRI abnormalities did not significantly affect gait outcomes; selective motor control predicted specific joint angle improvements but not overall gait quality.

Conclusions:

  • Functional mobility level (GMFCS) and baseline gait quality (EVGS) are key predictors of long-term gait outcomes after SDR.
  • SDR is an effective intervention for improving gait in children with spastic diplegia, including those with brain MRI abnormalities.
  • Careful patient selection based on these factors can maximize the success of SDR.
Abstract

Keywords:
Cerebral palsyKinematicsRehabilitationSelective motor controlSpastic diplegia

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