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Effects of selective dorsal rhizotomy on gait in children with cerebral palsy
L F Boscarino1, S Ounpuu, R B Davis
1Gait Analysis Laboratory, Newington Children's Hospital, Connecticut.
Insights
Selective dorsal rhizotomy (SDR) surgery improved walking patterns in children with cerebral palsy (CP). Gait analyses showed better joint motion and reduced spasticity after SDR, benefiting both independent and aided walkers.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) often impairs gait due to spasticity.
- Selective dorsal rhizotomy (SDR) is a surgical option to reduce spasticity.
Purpose of the Study:
- To evaluate the impact of SDR on gait patterns in children with CP.
- To quantify changes in joint motion and muscle tone post-SDR.
Main Methods:
- Gait analysis (3D motion, EMG) and clinical assessments (ROM, tone) were performed pre- and post-SDR.
- Nineteen ambulatory children with CP were studied, divided into independent and dependent ambulators.
Main Results:
- SDR led to improved passive range of motion and reduced lower extremity spasticity.
- Significant improvements in sagittal plane hip, knee, and ankle motion were observed.
- A more plantar-grade foot position during stance was noted post-surgery.
Conclusions:
- Selective dorsal rhizotomy (SDR) positively impacts specific gait parameters in children with cerebral palsy (CP).
- The procedure enhances joint mobility and reduces spasticity, leading to improved walking mechanics.
Abstract:
We wished to examine the effects of selective dorsal rhizotomy (SDR) on the gait patterns of children with cerebral palsy (CP). Nineteen ambulatory children underwent preoperative and 1-year postoperative gait analyses that included clinical assessment of joint range of motion (ROM) and muscle tone, three-dimensional motion analysis, and dynamic electromyography (EMG). The children were divided into two groups: independent ambulators (n = 11) and dependent ambulators (requiring a walking aid) (n = 8). Improvements in joint passive ROM and a reduction in lower extremity spasticity were noted. In both groups, positive pre- to postoperative improvements were noted in sagittal plane hip, knee, and ankle motion and there was a greater incidence of a plantar-grade foot position in stance. There was no change in the coronal plane motion of the pelvis and hip. A mean increase in anterior pelvic tilt for the independent ambulators was the only major negative change observed in this study. We conclude that SDR improves specific gait parameters in children with CP.