Long term follow up of children post selective dorsal rhizotomy (SDR) – the effect of the adolescent growth spurt on gait

Main topics:Analysis of clinicalmovementdata,Outcomesafter clinical intervention, Rehabilitation Introduction andaim: TheRJAHOrthopaedicHospital has been performing Selective Dorsal Rhizotomy (SDR) procedures for children with cerebral palsy for almost 20 years. Children undergoing SDR have been followed up at regular intervals, including before and after the adolescent growth spurt. Our previously published 18 month follow up [1], showed positive outcomes as a result of careful patient selection. Many patients are now adults and we are reporting thedurability of theoutcomes through theperiodof rapid growth experienced during adolescence. Patients/materials and methods: A cohort of 17 ambulant adults was identified, who had an SDR during childhood (average age 8.4). All patients had been assessed at three time points, preoperatively (PRE) and at two time points postoperatively (POST1 and POST2). POST1 was performed at age 10 for girls and 12 for boys (pre-pubertal) and the POST2 at 16 for girls and 18 for boys (postpubertal). At each time point instrumented 3D gait analysis was performed, along with a full clinical examination. Within subject analysis of variancewas determined using Friedman andWilcoxon signed ranks tests at a significance level of p=0.05 (2-tailed). Results: Table 1. Discussion and conclusions:We are reporting the durability of SDR through the adolescent growth spurt and into adulthood, with an average follow up time at POST2 of 9.7 years post op. The second column in Table 1 compares pre-operative gait data with the outcome post-adolescence. Statistically significant positive changes are observed inmany parameters, including the global measures of gait function (GPS and walking speed). The greatest changes are observed in the parameters most directly linked to spasticity, for example an increasedMaximumRate of Knee Flexion in Swing as a result of reduction in rectus femoris spasticity. The only negative change observed is an increase in anterior pelvic tilt. Positive changes were also seen in clinical examination measures (not reported here). The third column in the table shows the changes during the adolescent growth spurt. Little change is observed during this period, though patients did continue to improve their swing phase knee