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Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral
Eline A M Bolster1, Petra E M van Schie, Jules G Becher
1Department of Rehabilitation Medicine, Physiotherapy Section, VU University Medical Center, Amsterdam, the Netherlands.
Insights
Selective dorsal rhizotomy (SDR) improved gross motor function in children with spastic bilateral cerebral palsy (CP) long-term. Some children showed greater improvement than expected, though additional treatments were still needed.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Spastic bilateral cerebral palsy (CP) significantly impacts gross motor function.
- Selective dorsal rhizotomy (SDR) is a surgical intervention aimed at reducing spasticity.
- Long-term outcomes of SDR on motor function in ambulant CP populations require further investigation.
Purpose of the Study:
- To assess the long-term effects of SDR on gross motor function in ambulant children with spastic bilateral CP.
- To compare the functional outcomes with established reference centiles.
- To identify any long-term side effects or need for subsequent treatments.
Main Methods:
- Prospective cohort study of 29 children with spastic bilateral CP (GMFCS levels I-III).
- Gross Motor Function Measure (GMFM-66) scores were used to calculate individual centiles over 5 and 10 years post-SDR.
- Improvement defined as >20 centile change; side effects and additional treatments were recorded.
Main Results:
- No deterioration in gross motor function was observed based on centile ranking over 10 years.
- Five years post-SDR, 10/28 children improved; 10 years post-SDR, 6/20 children improved beyond expected centiles.
- Reported side effects included spinal issues (2) and hip subluxation (3); 13 children required subtalar arthrodesis, 5 tibial osteotomy, and 13 botulinum toxin treatment.
Conclusions:
- SDR appears to provide sustained or improved gross motor function in select ambulant children with spastic bilateral CP.
- The study supports the adequacy of current selection criteria for SDR.
- Despite functional gains, comprehensive management including additional orthopedic and medical interventions remains crucial post-SDR.
Aim:
The aim of this study was to evaluate the long-term effect of selective dorsal rhizotomy (SDR) on the gross motor function of ambulant children with spastic bilateral cerebral palsy (CP), compared with reference centiles.
Method:
The study used a prospective cohort design and participants comprised 29 children classified using the Gross Motor Function Classification System (GMFCS) in level I (n=7), II (n=4), or III (n=18; 18 males, 11 females; median age at time of surgery 6 y 4 mo; range 2 y 10 mo-12 y 1 mo), who were examined 5 years and 10 years after SDR. We used individual centiles based on Gross Motor Function Measure (GMFM-66) scores and age, corresponding to the GMFCS levels. Individual improvement or deterioration was defined as a change of more than 20 centiles. Side effects experienced and additional treatment received after SDR were also recorded.
Results:
Five years after SDR, 10 out of 28 children showed improvement, and 10 years after SDR 6 out of 20 children had improved. Spinal side effects were noted in two children and hip subluxation in three. Additional treatments included subtalar arthrodesis (n=13), endorotational osteotomy of the tibia (n=5), and botulinum toxin treatment (n=13).
Interpretation:
None of the children showed deterioration of gross motor function based on centile ranking. Five and 10 years after SDR, gross motor function in some children had improved more than would have been expected according to the reference centiles. This suggests, taking the limitations of this study into account, that the applied criteria for selection were adequate. However, the children still required additional treatment after SDR.
