Neuropediatrics 2023; 54(S 01): S1-S32
DOI: 10.1055/s-0043-1777188
Bewegungsstörungen

Short-Term Effects of Selective Dorsal Rhizotomy on Gait in Children with Bilateral Spastic Cerebral Palsy

Authors

  • M. Hösl

    1   Schön Klinik Vogtareuth, Gang- und Bewegunganalyselabor, Vogtareuth, Deutschland

  • A. Thamm

    1   Schön Klinik Vogtareuth, Gang- und Bewegunganalyselabor, Vogtareuth, Deutschland

  • M. Abel

    2   Schön Klinik Vogtareuth, Fachzentrum für Neurochirurgie, Epilepsiechirurgie, Wirbelsäulenchirurgie und Skoliose, Vogtareuth, Deutschland

  • M. Kudernatsch

    2   Schön Klinik Vogtareuth, Fachzentrum für Neurochirurgie, Epilepsiechirurgie, Wirbelsäulenchirurgie und Skoliose, Vogtareuth, Deutschland

  • H. Haberl

    2   Schön Klinik Vogtareuth, Fachzentrum für Neurochirurgie, Epilepsiechirurgie, Wirbelsäulenchirurgie und Skoliose, Vogtareuth, Deutschland

  • S. Berweck

    3   Schön Klinik Vogtareuth, Fachzentrum für Pädiatrische Neurologie, Neuro-Rehabilitation und Epileptologie, Vogtareuth, Deutschland
    4   Pädiatrische Neurologie, Ludwig-Maximilians-Universität (LMU), Entwicklungsneurologie, iSPZ Hauner dr. von Haunersches Kinderspital München, München,, Deutschland
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Background/Purpose: Selective dorsal rhizotomy (SDR) is a microsurgery to persistently reduce lower limb spasticity and improve function. We reviewed the short-term effects on gait in children with bilateral spastic cerebral palsy (BSCP) by 3D gait analysis (3DGA).

Methods: We included 36 children with BSCP, aged 5.8 ± 2.5 years. [2.6–11.7], scheduled for electrophysiologically guided SDR via single level laminoplasty. All received a 3DGA beforehand and at least 6 months after. The cohort was stratified into GMFCS Level I–II (N = 13) versus III–IV (N = 23) and subdivided into those who did or did not receive prior myofasciotomies (N = 16 vs. 20). During 3DGA, tempospatial parameters, the gait profile score (GPS), and statistical parametric mapping (SPM) for joint angles were focused. We also analyzed confounders, such as age, time since SDR, and initial gait pathology.

Results: Sixteen children had a previous myofasciotomy (∆t: 11.2 ± 8.9 months). Time since SDR was 7.5 ± 1.9 months. In GMFCS I–II, tempospatial parameters, and GPS, improvement was not yet significant (p ≥ 0.170), but SPM revealed a sign gain of knee flexion during swing phase. Children in GMFCS III–IV walked 8.6% faster, taking 8.7% longer and 16.5% wider steps. SPM revealed more hip and knee extension, less hip adduction, and less inward foot rotation. Concerning the GPS, younger children (r = 0.23, p = 0.05), without previous myofasciotomy (p = 0.017) and larger preoperative GPS deviation (R = −0.482, p < 0.01), overall showed a better outcome. Concerning walking speed, younger age (r = −0.29, p = 0.015), longer time since SDR (R = 0.295, p = 0.012), and slower preoperative walking speed (r = 0.357, p = 0.002) correlated with a better response.

Conclusion: SDR resulted in short-term gait improvements. Younger age, higher GMFCS-level, more kinematic alterations, and reduced walking speed increased the potential for improvement. As full effects may be reached earliest after 1 year, longer follow-up is expected to show better results, yet a short interval to prior myofasciotomy may delay recovery.



Publication History

Article published online:
13 November 2023

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