Selective dorsal rhizotomy versus orthopedic surgery: a multidimensional assessment of outcome efficacy

Abstract

Buckon CE, Thomas SS, Piatt JH Jr, Aiona MD, Sussman MD. Selective dorsal rhizotomy versus orthopedic surgery: a multidimensional assessment of outcome efficacy. Arch Phys Med Rehabil 2004;85:457–65. Objective To compare the efficacy of selective dorsal rhizotomy (SDR) and orthopedic surgery using multidimensional (National Center for Medical Rehabilitation Research disablement framework) outcome measures. Design Prospective outcome study. Setting Pediatric orthopedic hospital. Participants Twenty-five children with spastic diplegia. Eighteen participants (mean age, 71.3mo) chose SDR. Seven participants (mean age, 78.6mo) chose orthopedic surgery. Interventions Children were evaluated 2 days before surgical intervention and at 6 months, 1 year, and 2 years postsurgically. Main outcome measures The Gross Motor Performance Measure, the Gross Motor Function Measure, and the Pediatric Evaluation of Disability Inventory. Results The SDR group improved significantly in quality of movement attributes 6 months postsurgically; however, gross motor skills (standing; walking, running, and jumping) gains were seen 2 years postsurgically. The orthopedic group improved significantly in select quality of movement attributes 6 months postsurgically and in standing skills within the first postsurgical year. Self-care skills, mobility, and social function gains were seen earlier and with greater frequency in the SDR group. Conclusions Both surgical interventions demonstrated multidimensional benefits for ambulatory children with spastic diplegia. The results suggest that qualitative changes in movement, achieved by spasticity reduction, have a greater effect on the enhancement of functional skill proficiency, thus independence, than recognized.