ABSTRACT
In spastic diplegia of cerebral palsy, migration of the femoral head beyond a lateral edge of the acetabulum is a common orthopedic deformity and requires surgical treatment. We investigated whether selective dorsal rhizotomy for spastic diplegia halts or exacerbates lateral hip migration. The Reimers migration percentage computed from preoperative and postoperative hip radiographs was used as an index of the severity of lateral hip migration in all 134 hips of 67 children examined. At the time of rhizotomy, 38 patients were between 2 and 4 years of age and 29 were between 5 and 11 years of age. The follow-up period ranged from 6 to 10 months in 20 patients and from 15 to 46 months in 47 patients. Overall, the MP remained unchanged in 75% decreased in 17% and increased in 7%; thus, 93% of all hips examined were stable radiographically. Although most patients experienced postoperative hip stability, there was a significant trend for patients with greater preoperative migration to show decreased postoperative migration. The preoperative ambulatory status of patients had no impact on hip stability after dorsal rhizotomy. By the last follow-up, only 1 patient had undergone orthopedic operations for a persistent hip deformity. The results suggest that in children with spastic diplegia, selective dorsal rhizotomy halts lateral hip migration in the great majority of cases.
Subject(s)
Cerebral Palsy/surgery , Hip Dislocation/surgery , Hip Joint/surgery , Muscle Spasticity/surgery , Paraplegia/surgery , Spinal Nerve Roots/surgery , Adolescent , Cerebral Palsy/physiopathology , Child , Child, Preschool , Female , Hip Dislocation/physiopathology , Hip Joint/innervation , Hip Joint/physiopathology , Humans , Joint Instability/physiopathology , Joint Instability/surgery , Locomotion/physiology , Male , Muscle Spasticity/physiopathology , Paraplegia/physiopathology , Postoperative Complications/physiopathology , Range of Motion, Articular/physiology , Spinal Nerve Roots/physiopathology , Treatment OutcomeABSTRACT
We describe a variation of selective dorsal rhizotomy for spastic cerebral palsy that involves sectioning of the dorsal spinal roots immediately caudal to the conus medullaris. The operation entails an L1-L2 laminectomy, ultrasonographic localization of the conus medullaris, and partial deafferentation of the L1-S2 roots with electromyographic testing under an operating microscope. In 66 children with cerebral palsy, the operation reduced spasticity in the lower extremity without complications, e.g., motor weakness, neurogenic bladder, and sensory loss. It offers several important advantages over alternative techniques.
