Selective dorsal rhizotomy: long-term experience from Cape Town |
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Authors: | Nelleke G Langerak Robert P Lamberts A Graham Fieggen Jonathan C Peter Warwick J Peacock Christopher L Vaughan |
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Institution: | (1) MRC/UCT Medical Imaging Research Unit, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, Western Cape, 7925, South Africa;(2) Department of Paediatric Neurosurgery, Red Cross Children’s War Memorial Hospital, Rondebosch, Cape Town, Western Cape, 7700, South Africa;(3) Department of Neurological Surgery, University of California, San Francisco, CA, USA |
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Abstract: | Introduction Given the large number of cerebral palsy patients who have undergone selective dorsal rhizotomy in the past two decades, it
is clearly imperative that the clinical community be provided with objective and compelling evidence of the long-term sequelae
of the procedure.
Materials and methods In the early 1980s, Peacock in Cape Town shifted the site of the rhizotomy from the conus medullaris to the cauda equina,
and in the past 25 years, more than 200 children have been operated on. We have studied the incidence of spinal deformities
after multiple-level laminectomy and recorded a 20% incidence of isthmic spondylolysis or grade-I spondylolisthesis. We have
also conducted a long-term prospective gait analysis study on a cohort of 14 ambulatory patients who were operated on in 1985.
Results Ten years after surgery, our patients had increased ranges of motion that were within normal limits. Step length was significantly
improved, although cadence was unchanged postoperatively and was significantly less than normal age-matched control subjects.
Discussion We have recently tracked down all 14 patients from the original cohort and are currently completing a 20-year prospective
follow-up analysis of their neuromuscular function and gait. Our preliminary data suggest that selective dorsal rhizotomy
is not only an effective method for alleviating spasticity but it also leads to long-term functional benefits. |
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Keywords: | Children Cerebral palsy Dorsal rhizotomy Spinal deformity Gait analysis |
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