Article

The aim of this study was to evaluate the long-term effects of selective
dorsal rhizotomy (SDR) in children with cerebral palsy (CP).
METHOD: Nineteen
children (four females, 15 males; mean age 4y 7mo, SD 1y 7mo) with bilateral
spastic CP, were prospectively assessed at baseline and 18 months, 3 years, and
10 years after SDR. Assessments included the Modified Ashworth Scale for
spasticity, the Gross Motor Function Measure 88 (GMFM-88) and the Wilson gait
scale for ambulation, neurological investigations, and passive joint range of
motion assessment. A 10-year retrospective chart review was added for orthopaedic
surgery after SDR. RESULTS: Baseline muscle tone at the hip, knee, and ankle
level displayed a high degree of spasticity that normalized after SDR. After 10
years there was a slight recurrence of spasticity at the knee and ankle. Joint
range of motion declined from a maximum at 3 years after SDR to the 10-year
follow-up. Median ambulatory status was best 3 years after SDR and then declined.
The GMFM-88 score increased from the median baseline value of 51 to 66 (p=0.002)
and 76 (p<0.001) at the initial follow-ups. After 10 years there was a decline in
gross motor function with a reduction in the GMFM-88 score to 62 (p=0.022).
Within 10 years, 16 out of 19 patients had a mean of three orthopaedic surgeries
(SD 2.8), soft tissue surgery being the most common. INTERPRETATION: The
spasticity-reducing effect of SDR, although pronounced, did not seem to improve
long-term functioning or prevent contractures. This suggests that contracture
development in CP is not mediated by spasticity alone.
CI - (c) 2011 The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS