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Published on: February 2, 2024
Short- and long-term effects of selective dorsal rhizotomy on gross motor function in ambulatory children with
Petra E M van Schie1, Maaike Schothorst, Annet J Dallmeijer
1Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands. pem.vanschie@vumc.nl
Insights
Selective dorsal rhizotomy (SDR) improves gross motor function in children with spastic diplegia long-term, with no spasticity relapse. Many children still required additional treatments like surgery or botulinum toxin A.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Spastic diplegia is a common form of cerebral palsy affecting motor function.
- Selective dorsal rhizotomy (SDR) is a surgical procedure aimed at reducing spasticity.
- Evaluating the long-term efficacy of SDR is crucial for treatment planning.
Purpose of the Study:
- To assess the short-term and long-term effects of SDR on gross motor function and spasticity in children with spastic diplegia.
- To investigate associated side effects, need for further treatments, and parental satisfaction post-SDR.
Main Methods:
- Prospective cohort study including 33 ambulatory children with spastic diplegia who underwent SDR.
- Gross motor function assessed using the Gross Motor Function Measure-66 (GMFM-66).
- Spasticity measured via modified Tardieu scale; side effects and treatments documented through questionnaires and medical records.
Main Results:
- Significant improvements in GMFM-66 scores at 1-year (4.3 points) and long-term follow-up (6.5 points).
- Children at GMFCS Levels I-III showed functional gains, with greater initial improvement in Levels I and II.
- No spasticity relapse observed; 30% required orthopedic surgery, 39% received botulinum toxin A; 91% of parents reported improved functioning.
Conclusions:
- SDR provides sustained improvements in gross motor function and reduces spasticity in children with spastic diplegia.
- While effective, SDR does not eliminate the need for subsequent interventions such as surgery or botulinum toxin A.
- Parental satisfaction is high, indicating perceived benefits of SDR in managing spastic diplegia.
Object:
The primary aim of this prospective cohort study was to evaluate the short-term (1 year) and long-term (mean 6 years) effects of selective dorsal rhizotomy (SDR) on gross motor function and spasticity in ambulatory children with spastic diplegia. Secondary aims were to investigate side effects, additional treatment during follow-up (botulinum toxin type A injections or orthopedic surgery), and parental satisfaction.
Methods:
Thirty-three children who had undergone SDR at a mean age of 6 years and 7 months (± 2 years) were included. There were 7 children at Gross Motor Function Classification System (GMFCS) Level I, 7 at Level II, and 19 at Level III. Gross motor function was assessed with the Gross Motor Function Measure-66 (GMFM-66). Spasticity was measured according to a modified Tardieu scale. Side effects, additional treatment, and parental satisfaction were recorded using a parental questionnaire and medical records.
Results:
At 1-year follow-up, mean GMFM-66 scores improved significantly by 4.3 ± 4.1 points. Children at GMFCS Levels I and II showed significantly more improvement (7.2 points) on the GMFM-66 compared with children at GMFCS Level III (2.9 points). On long-term follow-up (mean 6 years ± 22 months), mean GMFM-66 scores improved significantly by 6.5 ± 5.9 points, without a difference between children at GMFCS Levels I and II and Level III. No relapse of spasticity was noted. Ten children (30%) needed orthopedic surgery and 13 children (39%) received botulinum toxin type A treatment after SDR. Twenty (91%) of the 22 parents who answered the questionnaire at long-term follow-up believed that their child's functioning had improved after SDR.
Conclusions:
Selective dorsal rhizotomy resulted in short- and long-term improvements in gross motor function, without relapse of spasticity. However, the majority of the children still needed additional surgery or botulinum toxin A treatment.
