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Role of femoral derotation on gait after selective dorsal rhizotomy in children with spastic cerebral palsy
Author(s) -
Van Campenhout Anja,
Huenaerts Catherine,
Poulussen Liesbeth,
Prinsen Sandra D,
Desloovere Kaat
Publication year - 2019
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14192
Subject(s) - rhizotomy , pelvic tilt , gait , cerebral palsy , medicine , gait analysis , ankle , physical medicine and rehabilitation , spastic , spastic diplegia , surgery , pelvis , dorsum , anatomy
Aim To evaluate the long‐term outcome of selective dorsal rhizotomy ( SDR ) on gait and the influence of previous femoral derotation osteotomy ( FDO ). Method In a retrospective cohort study of 29 children (16 females, 13 males) with spastic diplegic cerebral palsy, 14 children received FDO before SDR , whereas 15 children with moderate or near‐normal internal femoral rotation during gait received only SDR . Three‐dimensional gait data were obtained pre‐ FDO , pre‐ SDR , 1 year post‐ SDR , and 3 to 5 years post‐ SDR , to study the Gait Profile Score ( GPS ), pelvic tilt, and knee and hip kinematics. A mixed analysis of variance with the repeated measure ‘time’ was performed between different time points for each group. Results Children who first underwent FDO and then SDR started with a more complex gait pathology but showed fewer gait deviations 3 to 5 years post‐ SDR , compared to children who only underwent SDR . This was reflected by a lower GPS and pelvic tilt, as well as less knee flexion in stance. Interpretation The effect of SDR on gait is only significant in the mid‐ to long‐term if the bony lever arms are also corrected. Thus, the clinical outcome after SDR is dependent on good proximal alignment. What this paper adds Pelvic tilt remains stable after femoral derotation osteotomy (FDO)+selective dorsal rhizotomy (SDR). But pelvic tilt deteriorates after SDR only. Hip and knee extension is better after FDO+SDR than after SDR only. Spasticity reduction (by SDR) combined with bony lever arm correction (by FDO) improves gait.