A prospective gait follow-up study 30 years after selective dorsal rhizotomy

Selective dorsal rhizotomy (SDR) is a neurosurgical procedure to reduce spasticity in the lower extremities of children with cerebral palsy (CP). The aim of this study was to evaluate gait 30 years after SDR in a prospectively studied cohort to provide clinicians and parents/caregivers with information about the long-term outcomes of this surgery.

This cohort was assessed preoperatively with 2D gait analysis in 1985 and followed up at 1 and 3 years postoperatively (short-term outcomes) and at 10, 20, and 30 years postoperatively (long-term outcomes). In the current study, these 2D data were reinforced with 3D gait analysis, including gait graphs, 17 kinematic parameters, and Gait Deviation Index (GDI).

Twelve adults with a mean (SD) age of 37.5 (3.3) years with spastic diplegic CP (Gross Motor Function Classification System levels I, II, and III in 4, 6, and 2 patients, respectively) who showed changes in the 2D gait parameters in the short term demonstrated stabilization of hip and knee range of motion and nondimensional temporal distance parameters in the long term (20-30 years), while hip and knee midrange values approached normative values. Although 3D gait analysis showed some abnormal parameters, 9 of the 17 kinematic parameters were within the normal range with a mean (SD) GDI of 73.6 (14.4).

The reduction in lower extremity muscle tone demonstrated on short-term follow-up was sustained in the long term, with some gait parameters approaching the norm in adulthood. Thirty years after SDR, adults with CP walked with a mild crouch gait and no signs of spasticity.