SELECTIVE DORSAL RHIZOTOMY AND RATES OF ORTHOPEDIC-SURGERY IN CHILDREN WITH SPASTIC CEREBRAL-PALSY

If the spasticity of cerebral palsy (CP) is reduced in children at a y oung age by selective dorsal rhizotomy, the incidence of lower-extremi ty deformities requiring orthopedic surgery may be reduced; however, t his has never been investigated in detail. The authors examined the ef fects of selective dorsal rhizotomy on rates of lower-extremity orthop edic surgery in 178 children with CP. Age at selective dorsal rhizotom y ranged from 2 to 19.3 years (mean 5.5 years) with follow-up interval s ranging from 24 to 70 months (mean 44 months). Spastic CP was classi fied as quadriplegia (33%), diplegia (65%), and hemiplegia (2%). To as sess the effects of early versus late rhizotomy on rates of orthopedic surgery, patients were grouped as follows: Group I underwent rhizotom y between 2 and 4 years of age (54 patients), and Group II underwent r hizotomy between 5 and 19 years of age (124 patients). Comparison of K aplan-Meier plots of lifetime orthopedic surgery rates revealed that G roup II underwent orthopedic surgery at a higher rate than Group I (p = 0.037). Analysis by procedure type revealed higher orthopedic surger y rates in Group II than Group I for heel cord releases (p = 0.0025), adductor releases (p = 0.018), and hamstring releases (p = 0.02). Orth opedic surgery rates were no higher for Group II compared to Group I f or ankle/foot operations (p = 0.023), femoral osteotomy (p = 0.25), il iopsoas releases (p = 0.35), and ''other'' operations (p = 0.013). The data indicate that early rhizotomy reduces the need for orthopedic su rgery for heel cord, hamstring, and adductor releases.