Evaluation of selective dorsal rhizotomy for the reduction of @entity508 in XXXX : a randomized controlled tria.

@entity1 @entity508 @entity306
Selective dorsal rhizotomy (SDR) is widely used to treat @entity508 in @entity1 with @entity306 ( @entity306 ) but has never been shown conclusively to improve functional outcome. The study was designed to measure changes in gross motor function in @entity1 1 year following rhizotomy compared with a control group receiving equivalent physiotherapy (PT) and occupational therapy (OT) with the exception that the rhizotomy group initially underwent a 6-week postoperative in- @entity1 therapy program. Twenty-four @entity1 (mean age 58 months) with mild to moderate @entity306 with @entity306 were randomly assigned to a therapy-only control group (CG) (N=12) or rhizotomy and therapy group (RG) (N=12). The Gross Motor Function Measure (GMFM) was administered at the baseline, 6-, and 12-month assessments. Extremity tone, range of motion (ROM), biomechanics of the ankle-stretch reflex, isometric contraction, and temporal gait components were also evaluated. GMFM scores in the RG improved by 12.1 percentage points versus 4.4 percentage points in the CG (P<0.02). RG knee and ankle tone was significantly reduced (P<0.005), associated with increased passive ankle ROM (P<0.001), and decreased soleus EMG reflex activity on forced dorsiflexion (P<0.008). Foot-floor contact pattern improved in the RG compared with the CG (P<0.05). In conclusion, SDR combined with PT and OT leads to significantly greater functional motor improvement at 1 year following surgery compared with PT and OT alone. This was achieved in part through reduced knee and ankle tone, increased ankle dorsiflexion ROM, and more normal foot-floor contact during walking.
