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Simultaneous femoral derotation osteotomy and selective dorsal rhizotomy in children with spastic cerebral palsy: A prospective follow-up of 3 cases

Journal Contribution - Journal Article

Background: Both spasticity and high femoral anteversion are common features in children with cerebral palsy (CP). Previous studies have shown that children with these symptoms benefit from both a selective dorsal rhizotomy (SDR) to lower tone in the muscles in the lower limb and from a femoral derotation osteotomy (FDO) to correct lever arms. Multiple procedures and a long rehabilitation period may be challenging for a young child. Therefore, both interventions have been organized simultaneously in selected indications at the University hospital of Leuven since 2016. Method: Data of the first patients who underwent simultaneous SDR-FDO with a two year longitudinal follow-up were studied. Three-dimensional gait analysis were obtained preoperative, at short (1 year) and medium (2 year) term postoperative to define the gait profile score (GPS) and specific gait features. Their medical history, postoperative complications, rehabilitation period and functional scales were described. Furthermore, these data were compared with a group of children with CP who underwent FDO prior to SDR and with a group who underwent SDR-only. Results: The GPS significantly improved in the three cases, exceeding the minimal clinically important difference. The result of the three patients equalized the group who underwent FDO and SDR at different time points. Moreover, a large decrease in their excessive anterior pelvic tilt, an improvement in hip extension and rotation and improvement of ankle and knee kinematics were seen. Functional mobility scale improved in all three patients. No serious events were reported. Only a small number of grade I and II complications, according to the Modified Clavien-Dindo system, were observed. Interpretation: In children who need both spasticity reduction and bony malformation correction, simultaneous FDO and SDR is a safe procedure that yields a significant improvement in gait with a reduction of hospital admissions.
Journal: Clinical Case Studies and Reports
ISSN: 2631-5416
Volume: 4
Pages: 1 - 8
Publication year:2021
Accessibility:Open