SELECTIVE DORSAL RHIZOTOMY AS A TREATMENT OPTION FOR CHILDREN WITH SPASTIC CEREBRAL-PALSY

Cerebral palsy is the most common motor disorder originating in childh ood and spasticity is the most frequent manifestation. The treatment s trategies to reduce spasticity and thereby ameliorate the attendant ga it abnormalities have included physiotherapy, orthoses, antispastic me dications, orthopaedic surgery and neurosurgery. Of these, the neurosu rgical procedure known as selective dorsal rhizotomy has gained widesp read exposure? and indeed acceptance, over the past two decades, despi te there being some controversy as to its efficacy. In this paper we r eview: cerebral palsy, including classification and treatment; selecti ve dorsal rhizotomy, including historical background, patient selectio n, operative procedure, clinical outcome and complications; and gait a nalysis studies, including temporal-distance parameters, joint kinemat ics, normalisation for growth, and long-term follow-up. Both the short -term (1 year) and long-term (10 years) evidence has demonstrated that selective dorsal rhizotomy not only reduces spasticity but it also pr ovides lasting functional benefits as measured by improved range of mo tion during gait. Rhizotomy is not a panacea for children with spastic diplegia but it is an important treatment option for the clinician to consider. (C) 1998 Elsevier Science B.V. All rights reserved.