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

Arch Phys Med Rehabil. 2004 Mar;85(3):457-65. doi: 10.1016/j.apmr.2003.05.009.


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, 71.3 mo) chose SDR. Seven participants (mean age, 78.6 mo) 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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cerebral Palsy / physiopathology
  • Cerebral Palsy / surgery*
  • Child
  • Child, Preschool
  • Disability Evaluation
  • Female
  • Humans
  • Male
  • Motor Activity / physiology*
  • Orthopedic Procedures*
  • Outcome and Process Assessment, Health Care*
  • Prospective Studies
  • Rhizotomy*
  • Spinal Nerve Roots / surgery*