Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy

J Neurosurg. 1997 Jan;86(1):34-9. doi: 10.3171/jns.1997.86.1.0034.

Abstract

If the spasticity of cerebral palsy (CP) is reduced in children at a young age by selective dorsal rhizotomy, the incidence of lower-extremity deformities requiring orthopedic surgery may be reduced; however, this has never been investigated in detail. The authors examined the effects of selective dorsal rhizotomy on rates of lower-extremity orthopedic surgery in 178 children with CP. Age at selective dorsal rhizotomy ranged from 2 to 19.3 years (mean 5.5 years) with follow-up intervals ranging from 24 to 70 months (mean 44 months). Spastic CP was classified as quadriplegia (33%), diplegia (65%), and hemiplegia (2%). To assess the effects of early versus late rhizotomy on rates of orthopedic surgery, patients were grouped as follows: Group I underwent rhizotomy between 2 and 4 years of age (54 patients), and Group II underwent rhizotomy between 5 and 19 years of age (124 patients). Comparison of Kaplan-Meier plots of lifetime orthopedic surgery rates revealed that Group II underwent orthopedic surgery at a higher rate than Group I (p = 0.037). Analysis by procedure type revealed higher orthopedic surgery 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). Orthopedic surgery rates were no higher for Group II compared to Group I for ankle/foot operations (p = 0.023), femoral osteotomy (p = 0.25), iliopsoas releases (p = 0.35), and "other" operations (p = 0.013). The data indicate that early rhizotomy reduces the need for orthopedic surgery for heel cord, hamstring, and adductor releases.

MeSH terms

  • Adolescent
  • Arm / surgery
  • Cerebral Palsy / surgery*
  • Child
  • Child, Preschool
  • Follow-Up Studies
  • Foot Deformities / surgery
  • Hemiplegia / surgery
  • Humans
  • Leg / surgery
  • Muscle Spasticity
  • Orthopedics / statistics & numerical data*
  • Reoperation
  • Retrospective Studies
  • Rhizotomy*