Long-term outcome after selective posterior rhizotomy in children with spastic cerebral palsy

A retrospective analysis of data collected prospectively was performed to d etermine the long-term outcome of lumbosacral selective posterior rhizotomy (SPR) in children with spastic cerebral palsy (CP). The study population c omprised children with spastic CP, who had SPR more than 4 years prior to t he time of the study and had quantitative standardized assessments of lower limb spasticity (Ashworth scale), range of motion measured goniometrically , muscle strength (MRC scale) and ambulatory function, both preoperatively and at 1 year after SPR. Children meeting these criteria were reassessed at 5 years after SPR using the sa me measures. Hip adductor spasticity, hip a bduction range of motion and quadriceps strength were chosen as the primary outcome measures for statistical analysis. Of 80 patients who met the entr y criteria for the study, 33 completed the 5-year assessments. Significant improvements in spasticity, range of motion and muscle strength were noted both at 1 year and at 5 years after SPR. The preoperative, 1-year and 5-yea r values were as follows: hip adductor spasticity (Ashworth scale) = 4.1, 2 .1, 2.2; hip abduction range of motion (degrees) = 20.4, 39.9, 31.7, and qu adriceps strength (MRC scale) = 3.6, 4.0, 4.1. Ambulatory function seemed t o be better at 1 and 5 years compared to baseline, but no statistical analy sis was done for this secondary outcome measure. It was concluded that impr ovements in lower limb motor outcome are present at 1 year after SPR, and t hat these improvements are generally maintained at 5 years. Copyright (C) 1 999 S. Karger AG, Basel.