Selective Dorsal Rhizotomy Leads to Short-term Improvements in Gait, Study Shows

Selective dorsal rhizotomy — a surgical method used to treat spasticity in people with cerebral palsy — leads to significant short-term improvements in gait, a new study shows.

“The short-term effects of selective dorsal rhizotomy on gait compared to matched cerebral palsy control groups” was published in the journal Plos One.

Spastic cerebral palsy, characterized mainly by muscle stiffness, is the most common type of cerebral palsy (CP). Spasticity is present in around 80 percent of people with CP.

Selective dorsal rhizotomy (SDR) involves cutting some of the sensory nerve fibers that come from the muscles and enter the spinal cord. While this technique has been shown to effectively reduce spasticity in people with CP, there is lack of evidence regarding whether this reduction in spasticity is associated with an improvement in gait (a person’s manner of walking) compared to other treatment options.

While the goal of conducting SDR in patients with CP is often to improve gait, the evidence of its success thus far is variable.

Therefore, a group of Irish researchers from the Central Remedial Clinic in Dublin conducted a study to evaluate whether SDR leads to short-term improvements in gait. Researchers also looked at the outcomes of SDR in patients who had undergone an additional orthopedic surgery known as soft tissue surgery, a standard orthopedic procedure that helps release muscles to improve joint motion and gait efficiency in CP patients.

“Our hypothesis was that those who had SDR would demonstrate improvements in gait beyond those seen in those who had no surgery,” the researchers stated.

Patients who underwent SDR (29 patients, among which 13 also underwent soft tissue surgery, SDR group) were subjected to gait analysis before and one year after SDR. Participants who did not undergo SDR (18 patients, non-SDR group) were picked as age-matched controls.

Patients who underwent SDR and soft-tissue surgery significantly improved several gait-associated parameters including step-lengths (length of step) and knee flexion (the measurable degree in which your leg is bent) at initial contact and mid-stance.

Patients also experienced improved ankle dorsiflexion (the extension of your foot at the ankle) and foot progression (the angle made by the long axis of the foot from the heel to the second metatarsal – the long bone of the foot — and the line of progression of gait).

Comparatively, patients who only underwent SDR had improved step-lengths, knee extension, foot progression, and timing of peak knee flexion.

None of these improvements in gait were seen in those who did not undergo SDR.

“Comparison with appropriate control groups in this study suggests that SDR alone contributes to these gait improvement rathers than concomitant soft-tissue lengthening or natural development,” the researchers said.

“[W]e have demonstrated that SDR results in improvement in many gait parameters at short-term follow-up. … While those who had concomitant orthopedic surgery demonstrated more improvements in gait kinematics, comparison with a control group who had no surgery found that a number of improvements in gait were attributable to SDR only,” the researchers concluded.