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Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. J Neurosurg 1997 Jan;86(1):34-9 PMID: 8988079

Pubmed ID

8988079

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.

Author List

Chicoine MR, Park TS, Kaufman BA

Author

Bruce A. Kaufman MD Professor in the Neurosurgery department at Medical College of Wisconsin




Scopus

2-s2.0-0031014940   52 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Arm
Cerebral Palsy
Child
Child, Preschool
Follow-Up Studies
Foot Deformities
Hemiplegia
Humans
Leg
Muscle Spasticity
Orthopedics
Reoperation
Retrospective Studies
Rhizotomy
jenkins-FCD Prod-336 69ef4a6b262d135130251597d5d39873903802b5