Comparison of functional outcomes from orthopedic and neurosurgical interventions in spastic diplegia

Abstract

Selective dorsal rhizotomy (SDR) and orthopedic surgery, in the form of muscle-tendon (MT) lengthening surgery are commonly performed in ambulatory children with spastic diplegia to improve their level of motor function. This investigation is a post hoc comparison of the functional effects from each of these surgical options in 30 patients with spastic diplegia who underwent one of these interventions as their initial surgical procedure. Sixteen children underwent SDR and 14 underwent MT surgery in two separate prospective clinical trials. The same functional outcome measures preoperatively and approximately 1 year postoperatively were used in both studies including temporospatial parameters from three-dimensional gait analysis, the total score, and score on each of the five dimensions of the Gross Motor Function Measure (GMFM). Comparisons indicate that patients who underwent SDR had significant improvements in GMFM Dimensions 2, 4, and 5 as well as in total score, although 63% of those studied had a 10% or more reduction in gait velocity. Gait was more predictably improved in the MT group, with only 21% demonstrating reductions in velocity. Conversely, the change in GMFM scores in the MT group was not as pervasive and skewed toward higher skills with only GMFM Dimension 5 and total score improved significantly. Several important hypotheses are derived from these comparisons. Multicenter clinical trials are needed to define more clearly the indications for and to assess more comprehensively the outcomes from each intervention.