Author:
Chicoine Michael R.,Park T. S.,Kaufman Bruce A.
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.
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Reference23 articles.
1. Selective posterior rhizotomy: a long-term follow-up study
2. Varus and Valgus Deformities of the Foot in Cerebral Palsy
3. Bleck EE:Orthopaedic Management in Cerebral Palsy.London: MacKeith Press, 1987, pp 1–497
4. Delpech JM:Chirurgie Clinique de Montpelier, ou Observations et Réflexions Tirées de Travaux de Chirurgie Clinique de Cette École.Paris: Gabon et Cie, 1823, pp 147–231
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