Article

The aim of this study was to explore changes in motor function up to 10 years
after selective dorsal rhizotomy (SDR). Method The participants comprised 29
children (20 males, nine females) with bilateral spastic diplegia who were
consecutively operated on at a median age of 4 years and 3 months and followed
until a median age of 15 years. SDR was combined with physiotherapy and regular
follow-up visits. The distribution of preoperative Gross Motor Function
Classification System (GMFCS) levels was as follows: I, n=1; II, n=7; III, n=8;
IV, n=12; and V, n=1. Muscle tone in hip flexors, hip adductors, knee flexors,
and plantar flexors was assessed with the modified Ashworth scale, passive range
of motion in hip abduction, popliteal angle, maximum knee extension, dorsiflexion
of the foot was measured with a goniometer, and gross motor function was assessed
using the Gross Motor Function Measure (GMFM-66). The results were compared with
preoperative values, taking into account age at the time of SDR. Results After 10
years, muscle tone in hip flexors, hip adductors, knee flexors and plantar
flexors was normalized in 19, 24, 13 and 23 participants respectively; mean
change in passive range of motion ranged from -2.0 degrees to 8.6 degrees , and
the mean increase in GMFM-66 was 10.6. Changes in GMFM-66 were associated with
preoperative GMFCS level and GMFM-66 scores. Interpretation Children who
underwent SDR and physiotherapy and were regularly followed up by an experienced
team showed improved gross motor function for up to 10 years postoperatively.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2012 Mac Keith
Press.

Langue : ANGLAIS