Contents lists available at ScienceDirect Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost Full length article Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood: A 10 year follow-up study Marianna Romei a , Laura M. Oudenhoven a , Petra E.M. van Schie a , Willem J.R. van Ouwerkerk b , Marjolein M. van der Krogt a , Annemieke I. Buizer a, ⁎ a Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands b Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands ARTICLE INFO Keywords: Cerebral palsy Kinematics Longitudinal study Edinburgh visual gait score Rehabilitation ABSTRACT Background: Short-term benefit on gait of selective dorsal rhizotomy (SDR) surgery, which relieves spasticity of the lower extremities has been demonstrated in children with cerebral palsy (CP). However very little is known of the evolution of gait when patients become adolescents and young adults. Research question: How does the gait pattern evolve in adolescents and young adults who underwent SDR during childhood? Methods: A longitudinal study was performed including 19 ambulant patients with spastic diplegia due to CP or other causes (mean age at SDR: 6.6 ± 1.6 years) who were assessed four times: pre-SDR, 2 years post- SDR, 5 years post-SDR and at least 10 years post-SDR. From 2D video recordings, Edinburgh Visual Gait Score and lower limb joint kinematic parameters were calculated. Results: Our data show that the improvement in the gait pattern obtained short-term after SDR continues during into adolescence and adulthood. Ten years after SDR all patients improved compared to baseline. Considering the lower limb joint kinematics, most notable improvements were found at knee and ankle joints. Compared to the evaluation before SDR, the range of motion of the knee increased: the knee was more extended at initial contact and knee flexion in midswing improved. Excessive ankle plantar flexion was reduced during the entire gait cycle. Only minor changes were found at hip and pelvis. Eight patients underwent additional orthopaedic surgery in the years after SDR, and the present findings should be considered as a combination of SDR, devel- opment and additional treatment. Significance: We demonstrate lasting improvement of gait quality in ambulant patients with spastic diplegia who underwent SDR during childhood when they become adolescents and young adults. 1. Introduction Selective dorsal rhizotomy (SDR) is a neurosurgical procedure aimed at eliminating spasticity in the lower limbs and thereby im- proving walking ability of patients with cerebral palsy (CP). Short-term benefits of SDR on the gait pattern have been demonstrated [1–5], with selection of suitable candidates for SDR and the definition of the in- dividual goals being crucial to evaluate and interpret the outcomes [3,5]. Long-term follow-up studies have mainly focused on the effect of SDR on functional ability measured by the Gross Motor Function Measure (GMFM-66) [6–8] or questionnaires [9,10] and the results are controversial. Lundkvist Josenby et al. [6] found progressive im- provement in gross motor function over 10 years after SDR, and Bolster et al. [8] reported that gross motor function in some children improved more than expected, noting that most of the patients underwent addi- tional orthopaedic surgery. However, Tedroff et al. [11] concluded that despite the fact that the spasticity-reducing effect of SDR was main- tained, this did not seem to improve long-term functioning or prevent contractures in patients with CP. The number of studies that have evaluated the long-term (more than 10 years) effect of SDR on gait using kinematic parameters is limited. It has previously been reported that knee and hip joint motion during gait improved in patients affected with spastic CP 10 years after SDR [12] and 20 years after SDR [13]. Langerak et al. [14] compared gait kine- matics of 31 adults who had undergone SDR during their childhood to age-matched healthy adults using 3D gait analysis (3DGA). The most relevant difference with the control group was that patients walked https://doi.org/10.1016/j.gaitpost.2018.06.002 Received 9 February 2018; Received in revised form 20 April 2018; Accepted 3 June 2018 ⁎ Corresponding author. E-mail addresses: m.romei@vumc.nl (M. Romei), l.oudenhoven@vumc.nl (L.M. Oudenhoven), pem.vanschie@vumc.nl (P.E.M. van Schie), W.vOuwerkerk@vumc.nl (W.J.R. van Ouwerkerk), m.vanderkrogt@vumc.nl (M.M. van der Krogt), ai.buizer@vumc.nl (A.I. Buizer). Gait & Posture 64 (2018) 108–113 0966-6362/ © 2018 Published by Elsevier B.V. T