Functional assessment of children with cerebral palsy following limited (L4-S1) Selective Posterior Rhizotomy - A preliminary report

Objective. Selective Posterior Rhizotomy (SPR) is effective for reducing sp asticity in children with cerebral palsy (CP). Nonetheless, extensive senso ry deafferentation associated with this procedure can lead to prolonged pos toperative hypotonia that delays the functional recovery of the patient. As lumbar rhizotomy provokes suprasegmental hypotonia, we hypothesized that r educing the extent of the deafferentation to the roots of L4-S1 levels woul d reduce the risk of postoperative hypotonia. Methods and Results. Five patients with spastic cerebral palsy (4 males and 1 females, age range: 4 12 years) underwent limited selective dorsal rhizo tomy (LSDR) of three (L4-S1) dorsal roots. All patients were able to walk i ndependently prior to surgery. Functional assessments of these patients wer e performed pre and post operatively. Assessments included spasticity evalu ation, passive range of motion, and sagittal plane kinematics of the hip, k nee, and ankle during walking. Following surgery, reduced spasticity, incre ased passive range of motion and improved joint motion during walking was o bserved. Specifically, peak hip and knee extension and peak ankle dorsiflex ion increased while peak plantarflexion decreased. Conclusions. Strength and motor control were not adversely affected by this procedure in any of the subjects and all patients actually demonstrated im provements. Previous studies have demonstrated that LSDR is highly effectiv e in reducing spasticity and achieving functional outcome in spastic childr en. The results of this study demonstrated improved function during walking as assessed using gait analysis techniques.