Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Rehabilitation Medicine

Background:

• Spastic diplegia is a common form of cerebral palsy characterized by increased muscle tone and stiffness.
• Physiotherapy is a standard treatment, but its efficacy can be limited in improving gross motor function.
• Selective dorsal rhizotomy (SDR) is a surgical option aimed at reducing spasticity.

Purpose of the Study:

• To compare the efficacy of selective dorsal rhizotomy (SDR) plus physiotherapy (SDR+PT) versus physiotherapy-only (PT-only) in children with spastic diplegia.
• To evaluate the impact of SDR+PT on spasticity and gross motor function.
• To explore the relationship between the extent of SDR and functional outcomes.

Main Methods:

• A meta-analysis and comparative analysis of three randomized clinical trials.
• Pooled outcome data from 90 children with spastic diplegia at baseline and 9- to 12-month follow-up.
• Assessment of spasticity using the Ashworth scale and gross motor function using the Gross Motor Function Measure (GMFM).

Main Results:

• SDR+PT significantly reduced spasticity compared to PT-only (mean Ashworth scale difference -1.2, p<0.001).
• SDR+PT demonstrated greater improvement in gross motor function (mean GMFM difference +4.0, p=0.008).
• A positive correlation was observed between the percentage of dorsal root tissue transected during SDR and functional gains.

Conclusions:

• Selective dorsal rhizotomy combined with physiotherapy is an efficacious treatment for reducing spasticity in children with spastic diplegia.
• SDR+PT yields a small but significant positive effect on gross motor function in this population.
• The degree of dorsal root transection during SDR may influence the extent of functional improvement.