AIM: To compare short-term outcomes between conus medullaris (conus) and cauda equina (cauda) selective dorsal rhizotomy (SDR) techniques in children with spastic cerebral palsy.
METHOD: This was a retrospective review of SDR at a single center from 2013 to 2017. Gait and functional outcome measures were assessed at no more than 18 months pre-SDR (baseline) and 8 to 36 months post-SDR (follow-up). Transient complications during inpatient stay were quantified.
RESULTS: In total, 21 and 59 children underwent conus and cauda SDR respectively. Ashworth Scale scores were nearly normalized at follow-up. Most physical examination and functional measures exhibited similar baseline to follow-up responses for both groups. From baseline to follow-up, sagittal plane knee kinematics for both groups significantly improved (p<0.01) by 11° at initial contact, 9° to 10° in stance phase, and 4° in swing phase. Sagittal plane ankle kinematics improved more for the cauda group than the conus group in both stance phase (10° vs 2°, p<0.01) and swing phase (13° vs 3°, p<0.01). Post-surgical complications were similar between groups.
INTERPRETATION: Conus and cauda SDR techniques resulted in similar short-term outcomes except in ankle kinematics at follow-up. The cauda group exhibited a large improvement towards dorsiflexion, while there was residual equinus in the conus group despite Ashworth Scale scores normalizing equally in both groups.
WHAT THIS PAPER ADDS: Conus and cauda selective dorsal rhizotomy (SDR) resulted in mostly similar short-term gait and functional outcomes. Conus SDR resulted in residual equinus dynamically, despite normalized spasticity measures. Post-surgical complications were mostly similar between SDR techniques.
Bibliographical notePublisher Copyright:
© 2020 Mac Keith Press
Copyright 2021 Elsevier B.V., All rights reserved.
- Biomechanical Phenomena/physiology
- Cauda Equina/surgery
- Cerebral Palsy/physiopathology
- Child, Preschool
- Range of Motion, Articular/physiology
- Retrospective Studies
- Spinal Cord/surgery
- Treatment Outcome
PubMed: MeSH publication types
- Journal Article
- Comparative Study