Selective dorsal rhizotomy – selection criteria and outcome in the frst year after a new etablished invasive treatment

Objective: Children with cerebral palsy have been treated traditionally with physiotherapy, orthesis, botox injection, systemic drug therapy including intrathekal baclofen and orthopedic surgical intervention. Selective dorsal rhizotomy is a well evaluated treatment option, which has been shown to lead to significantl improve of GFMF, self care ability and gait patterns in ambulant children with cerebral palsy. Possible negative effects mainly the unmasking of weakness after removal of the spasticity and its consequences like development of scoliosis or aggravation of hip luxation. The method has been established in a few centers in Germany recently. To prove the effectiveness and safety of a new treatment option, very strict selection criteria in an interdisciplinary setting and standardised outcome assessment are required.

Patients: 6 patients with bilateral-spastic CP age 4 to 12 years, GMFCS II-IV, cognitive normal or mild disabled with periventricular leucomalacia in MRT

Methods: GMFCS, modified Tardieu-scale, modified Ashworth-scale, Goal Attainment Scaling, standardised videodocumentation (System Dartfish) before and 3, 6, 12 months after surgery

Results: All patients had a significant and sustained reduction of their spasticity in the lower limbs (median 2 points of Tardieu- and Ashworth Scale). After the expected initial functional decrease of walking and gait due to increase in weakness, all 6 patients got 0 or +1 points in goal attainment scaling and improved their gait within one year compared to baseline, especially regarding gait velocity, walking distance, and more physiologic gait pattern. 2 patients improved GMFCS (1 level), 4 didn't change level. There was no deterioration of hip position or development of spine deformity, neither clinically nor radiologically.