The short-term effects of selective dorsal rhizotomy on gait compared to matched cerebral palsy control groups

Abstract

Objectives To examine the short-term effects of selective dorsal rhizotomy (SDR) ± soft-tissue surgery on gait in cerebral palsy (CP) compared to matched controls with no surgical intervention. Methods Participants had gait analysis before and one year after SDR. Non SDR participants were retrospectively matched for age and all significant gait parameters. The SDR group was further subdivided into those who had concomitant orthopaedic surgery and those who had SDR only. Results The SDR group consisted of 29 participants (mean age 5.8 years at baseline, 7.7 years at follow-up). Of these, 13 had concomitant orthopaedic surgery. The non SDR group consisted of 18 participants (mean age at baseline 6.1 years, 8.1 years at follow-up). SDR ± soft-tissue surgery significantly improved step-lengths, knee flexion at initial contact and mid-stance, ankle dorsiflexion, foot progression and timing of peak knee flexion. None of these improvements in gait were seen without surgical intervention. While more improvements were seen in those who had SDR and orthopaedic surgery, SDR only resulted in improved step-lengths, knee extension, foot progression and timing of peak knee flexion. Conclusions SDR ± soft-tissue surgery results in short-term improvements in gait which are not seen without surgical intervention. While those who had SDR and soft-tissue surgery demonstrated more changes in gait, many improvements were attributable to SDR only.

Energy consumption does not change after selective dorsal rhizotomy in children with spastic cerebral palsy

“…To our knowledge, no studies have included a control group of peers with CP when looking at the impact of SDR on energy consumption. Our results demonstrate the critical importance of identifying and comparing to a cohort of peers with CP when evaluating treatments to differentiate whether observed changes are due to the treatment or natural development 27 …”

“…Our results demonstrate the critical importance of identifying and comparing to a cohort of peers with CP when evaluating treatments to differentiate whether observed changes are due to the treatment or natural development. 27 There are a few possible explanations for why spasticity does not affect energy consumption: (1) the additional muscle activity from spasticity does not increase energy consumption; (2) the additional muscle activity from spasticity is not large enough to have a large effect; (3) the spasticity measured by the Ashworth score does not reflect the muscle activity during gait; or (4) other factors beyond spasticity are the primary contributors to the elevated energy consumption in individuals with CP. Other possible contributors to elevated energy consumption in children with CP include poor selective motor control, 28 excessive cocontraction for stabilization, 29 and altered muscle properties.…”

Multidimensional Outcomes of Selective Dorsal Rhizotomy for Children With Spastic Cerebral Palsy: Single-Level Laminectomy vs Multiple-Level Laminotomy Techniques

“…At the same time, the cadence and walking speed remained similar to the preoperative status, consistent with previous reports. 29,30 Urological outcomes were conspicuously improved, including 7 patients with resolved urological symptoms and 6 patients with…”

“…At the same time, the cadence and walking speed remained similar to the preoperative status, consistent with previous reports. 29,30…”

Short-term reduction of ankle spasticity after surgical lengthening of the triceps surae in chronic post-stroke patients: a retrospective cohort study

“…Then, this new condition—i.e., joint range of motion and muscle activation patterns—is key to designing a tailored rehabilitation program. Finally, the assessment at the 1-month mark serves as the baseline reference for evaluating the effectiveness of the physiotherapy program and monitoring the patient’s recovery over time ( 21 ).…”