GAIT BEFORE AND 10 YEARS AFTER RHIZOTOMY IN CHILDREN WITH CEREBRAL-PALSY SPASTICITY

Object. Selective dorsal rhizotomy is a neurosurgical procedure perfor med for the relief of spasticity in children with cerebral palsy, but its long-term functional efficacy is still unknown. The authors sought to address this issue by means of an objective, prospective study in which quantitative gait analysis was used. Methods. Eleven children wi th spastic diplegia (mean age at initial surgery 7.8 years) were evalu ated preoperatively in 1985 and then at 1, 3, and at least 10 years af ter surgery. For comparison, 12 age-matched healthy individuals were a lso studied. Retroreflective targets were placed over the hip, knee, a nd ankle joints, and each individual's gait was videotaped. The video data were subsequently entered into a computer for extraction and anal ysis of the gait parameters. An analysis of variance yielded a signifi cant time effect (p < 0.05), and post hoc comparisons revealed differe nces before and after surgery and with respect to the healthy voluntee rs. The knee and hip ranges of motion (59 degrees and 44 degrees, resp ectively, for healthy volunteers) were significantly restricted in chi ldren with spastic diplegia prior to surgery (41 degrees and 41 degree s, respectively), but were within normal limits after 10 years (52 deg rees and 45 degrees, respectively). The knee and hip midrange values ( 31 degrees and 3 degrees, respectively, for healthy volunteers), Indic ative of posture, were significantly elevated preoperatively (42 degre es and 15 degrees) and increased sharply at 1 year (56 degrees and 18 degrees), but by 10 years they had decreased to within normal limits ( 36 degrees and 9 degrees). Step length and velocity improved postopera tively but were not within the normal range after 10 years. Ten years after surgery these patients not only had increased ranges of motion, but also used that movement at approximately a normal midrange point. Conclusions. Selective dorsal rhizotomy is an effective method for all eviating spasticity. Furthermore, the authors provide evidence to show that lasting functional benefits, as measured by improved gait, can a lso be obtained.