Author(s): LAMBERTS, R., VAUGHAN, C.L., FIEGGEN, G.A., PEACOCK, W.J., BRASELL, S.E., NOVACHECK, T., ENSLIN, J., LANGERAK, N.G., Institution: UNIVERSITY MEDICAL CENTRE GRONINGEN, UNIVERSITY OF GRONINGEN, Country: NETHERLANDS, Abstract-ID: 680

INTRODUCTION:
Selective dorsal rhizotomy (SDR) is a neurosurgical procedure used to reduce lower-limb spasticity in children with cerebral palsy (CP). While short- and medium-term outcomes are well documented, evidence on very long-term gait outcomes remains limited. This study investigated changes in 2D gait parameters at 1, 3, 10, 20, and 30 years following SDR, compared with typically developing (TD) adults. In addition, 3D gait parameters were compared between adults with CP at 30 years post-SDR and TD adults.
METHODS:
This prospective follow-up study included gait data collected preoperatively and at 1, 3, 10, 20 [1-4], and 30 years following SDR. Of the fourteen individuals with CP who participated in the original study [1], twelve adults were available for the 30-year follow-up. Gait analyses were performed at a self-selected speed along a 20 m walkway and captured using a 3D motion analysis system (Vicon, Oxford Metrics, UK). Standard lower-body Plug-in-Gait models were used for both 2D and 3D analyses. Seventeen kinematic parameters, the gait deviation index (GDI), and non-dimensional temporal–distance parameters (normalised to leg length) were analysed. Changes over time and differences between adults with CP and TD adults were examined using mixed-model two-way ANOVA, with Tukey post hoc tests applied where appropriate. Statistical significance was set at p < 0.05.
RESULTS:
Twelve adults with spastic diplegic CP who underwent SDR at a mean age of 7 ± 3 years participated in the study. Significant improvements in knee range of motion (ROM) were observed at 1 year (p = 0.049) and 3 years (p = 0.006) post-SDR, and in hip ROM at 1 year post-SDR (p = 0.002). These improvements, along with other gait parameters, remained stable up to 30 years post-SDR. Normalised step length (p = 0.16) and cadence (p = 0.07) remained stable over time, while normalised walking speed remained slower in adults with CP compared to TD adults (p = 0.024), consistent with findings at 10 and 20 years post-SDR. At 30 years post-SDR, 3D gait analysis revealed differences in 9 of 17 kinematic parameters between adults with CP and TD adults, primarily involving pelvic kinematics, hip extension, knee flexion, and ankle plantar flexion (p < 0.01). Despite these differences, the mean GDI (74 ± 14) remained within the functional range.
CONCLUSION:
When applied to appropriately selected children with spastic diplegia, SDR results in long-term improvements in gait. Although improvements in gait mainly occur within the first three years following surgery, gait parameters remain stable for up to 30 years post-SDR. Despite kinematic gait differences compared with TD adults, overall gait function remains within a functional range, which emphasises the long-term efficacy of SDR.

References
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