By Dr Caroline Stewart (Research Fellow in Bioengineering, ORLAU Manager, Institute for Science & Technology in Medicine, Keele University)
Long term results in novel surgery
Improving walking in children with cerebral palsy
In 1995 the Robert Jones and Agnes Hunt Orthopaedic
Hospital, partnered with ISTM, became the first centre in
the UK to offer a novel surgical technique known as Selective Dorsal Rhizotomy (SDR) to children with cerebral
palsy. The procedure involves selectively cutting a proportion of the tiny nerves going into the spinal cord at the
lower back. By reducing the over-sensitive sensory input
patients experience an improvement in their spasticity, a
common feature of cerebral palsy. After treatment children received an intensive in-patient therapy programme,
including provision of plastic ankle splints, which are
carefully set up in the gait laboratory.
In Oswestry our main objective has been to improve mobility, particularly walking. All children have had detailed
analysis of their walking before and after their surgery.
To do this we asked the children to walk in a laboratory
equipped with cameras able to track the movement of
their limbs in three dimensions. This technology has allowed us to quantify the impact of treatment on their
walking pattern. We published our first follow up study in
2007 (Cole et al., 2007), where we were able to report
positive outcomes from our initial group around 18
months after surgery. We associated these encouraging
results with our application of strict selection criteria, allowing us to choose those children who are most likely to
benefit.
After treatment children received an intensive
in-patient therapy programme
escent growth spurt, a challenging period for children with
cerebral palsy. Some (59%) of our patients needed
some additional surgery after their SDR, though fewer
procedures than we would have expected preWe have continued to follow up all our patients into adult- operatively. Overall the group maintained their improved
hood, allowing us to report the durability of the benefits
walking through adolescence and into adulthood, a result
seen. Our most recent publication (McFall et al 2015)
which supports the use of SDR in selected children. We
reports the quality of patients’ walking patterns at adulthave also published a review article this year (Roberts et
hood, with a particular focus on changes through the adol al 2015) reflecting our 20 years’ experience of offering
SDR.
“
Overall the group maintained their improved
walking through