Selective dorsal rhizotomy for children with spastic cerebral palsy: The Oswestry experience

Cole, G.F., Farmer, S.E., Roberts, A., Stewart, C. & Patrick, G.H.

Three randomised control trials have shown that selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy, meta analysis demonstrated only a small benefit to the patient from this operation. The purpose of the study was to analyse whether imposing strict patient selection criteria as in the Oswestry program leads to better outcomes; using gait analysis as an outcome measure.

Ambulant children with cerebral palsy were selected using the patient selection criteria. Of the 53 who were referred for the procedure, only 19 (35%) satisfied the criteria. These children underwent surgery. When analysing pre and post SDR data, improvements were seen in cosmesis of gait, clinical examination and temporal, kinetic and kinematic parameters of gait. Changes were seen at hip, knee and ankle, with those at the knee being the most marked.

Retrospectively, the Gross Motor Function Scale (GMFCS) confirmed the improvements. In conclusion, application of strict selection criteria when considering patients for this operation leads to encouraging results as demonstrated by gait analysis and other measures.

Archives of Disease in Childhood, 2007. (92): 781-785

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