We have been able to review the pre-operative, six-, 12- and 60-month post-operative tone and goniometric examinations of 48 children classified as walkers, crawlers or non-locomotors (evenly divided into these three groups). All had a statistically significant improvement in the tone of every muscle tested. Goniometric examination was also significantly improved in all except for the hip flexors and plantar flexors in the walking group. We have been able to meet the pre-operative functional goals set for our patients more than 80 percent of the time. Similar experiences have been reported by other groups. Peacock has found no return of spasticity in his patients, as has Fasano. Storrs observed improvement in more than 90 percent of his patients. However, it is becoming apparent that this is not a procedure guaranteed in and of itself to prevent the need for further surgery. Of our 350, 20 eventually needed hip osteotomies due to significant subluxation; more than half of these experienced progressive subluxation after rhizotomy, and 25 have required tendonotomy to treat range limitation in a joint.
In our experience, children who undergo this operation average 4.5 hours of physical therapy per week a year after surgery. After three years, they still receive two to three hours per week, and this is frequently augmented by the parents (in both stretching and strengthening activities). We examine the children six months after surgery and then on a yearly basis. Hip and spine X-rays are obtained as indicated (at least every two to three years), the functional status of the child is reviewed, orthotic devices inspected and concerns of the treating therapist(s) discussed. This post-operative support has allowed us to maintain immediate post-operative improvements in more than 90 percent of our patients.