Short-term change of tibial torsion in children with spastic cerebral palsy after selective dorsal rhizotomy

Background: Spastic cerebral palsy (CP) is a prevalent cause of motor dysfunction in children, with patients often experiencing secondary musculoskeletal deformities, including tibial torsion. This study aimed to investigate the short-term effect of selective dorsal rhizotomy (SDR) on tibial torsion in children with spastic CP. Methods: We conducted a retrospective review of children with spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, between July 2019 and November 2022. Preand post-operative physical assessments were examined. Results: A total of 148 children were included in the study. After SDR, there was a significant decrease in muscle tone in the lower limb muscle groups. Joint range of motion in the lower limbs also increased postsurgery. Bilateral transmalleolar angle (TMA) showed a significant increase after the surgery, and 21% limbs classified as internal tibial torsion before SDR changed into normal angle post-operatively. Limbs with better improvement after SDR derived from younger patients and had lower muscle tone in the hamstring muscles when compared to those that did not show improvement. Conclusions: SDR has the potential to increase TMA in children with spastic CP. Limbs classified as internal tibial torsion are more likely to improve after SDR if they have lower muscle tone in the hamstring muscles and are derived from younger patients.