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Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy
Tamir Ailon1, Richard Beauchamp, Stacey Miller
1Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and British Columbia Children's Hospital, 4480 Oak St., Room K3-159, Vancouver, BC, V6H 3V4, Canada.
Insights
Selective dorsal rhizotomy (SDR) offers lasting spasticity reduction in children with cerebral palsy. While early motor gains are seen, long-term benefits vary by GMFCS level, with sustained improvements in GMFCS II-III but not GMFCS IV-V.
Area of Science:
- Pediatric Neurosurgery
- Orthopedic Surgery
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy (CP) significantly impacts motor function and quality of life in children.
- Selective Dorsal Rhizotomy (SDR) is a surgical intervention aimed at reducing spasticity in CP.
- Long-term outcomes of SDR, particularly regarding sustained functional improvements, require further investigation.
Purpose of the Study:
- To evaluate the long-term efficacy of Selective Dorsal Rhizotomy (SDR) in managing spasticity and improving motor function in pediatric patients with cerebral palsy.
- To assess the durability of SDR's effects on hip adductor spasticity, hip range of motion, quadriceps strength, and overall motor function over a decade post-surgery.
- To compare long-term outcomes between different severity levels of cerebral palsy, as classified by the Gross Motor Function Classification System (GMFCS).
Main Methods:
- Retrospective review of a prospective database of pediatric patients who underwent SDR.
- Stratification of patients into two groups based on GMFCS levels: Group 1 (GMFCS II-III) and Group 2 (GMFCS IV-V).
- Assessment of spasticity, hip range of motion, quadriceps strength, and motor function at baseline, 6 months to 5 years, and over 10 years postoperatively.
Main Results:
- SDR demonstrated a significant and durable reduction in spasticity, with Modified Ashworth Scale scores decreasing significantly both early and late postoperatively (p < 0.0001).
- Early improvements in hip range of motion were observed but not sustained at long-term follow-up.
- Motor function improved in both GMFCS groups early on. Group 1 (GMFCS II-III) showed sustained gains (6.6 points from baseline, p=0.04), while Group 2 (GMFCS IV-V) experienced initial gains followed by a decline below baseline (p=0.3).
Conclusions:
- Selective Dorsal Rhizotomy (SDR) provides a lasting reduction in spasticity in children with cerebral palsy, extending beyond 10 years.
- While SDR leads to initial improvements in motor function, these gains are attenuated in the long term for patients with GMFCS levels II and III and are not sustained for those with GMFCS levels IV and V.
- These findings highlight the importance of patient stratification by GMFCS level when considering SDR and managing expectations for long-term functional outcomes.
Purpose:
The purpose of this study is to evaluate long-term outcomes after selective dorsal rhizotomy (SDR) for children with spastic cerebral palsy.
Methods:
This is a retrospective review of a prospective database of patients who underwent SDR at British Columbia Children's Hospital. Hip adductor spasticity, hip range of motion (ROM), quadriceps strength, and motor function were assessed pre-operatively, at 6 months to 5 years and more than 10 years postoperatively. Patients were stratified by Gross Motor Function Classification System (GMFCS) level into group 1 (GMFCS II and III) and group 2 (GMFCS IV and V).
Results:
Forty-four patients, with mean age at SDR of 4.5 years (range 2.9-7.7), were followed for a mean 14.4 years. Spasticity (Modified Ashworth Scale) decreased 1.5 (p < 0.0001) by early postoperative evaluation with further decrease at late evaluation of 0.8 (p < 0.0001). Early improvement in hip ROM of 13.7 degrees (p < 0.0001) was not sustained at late assessment. Motor function improved in both groups at early assessment but was only sustained in group 1. Group 1 increased 10.0 points (p < 0.0001) at early evaluation with subsequent decrease of 3.5, resulting in an overall increase of 6.6 (p = 0.04) from baseline. Group 2 patients had an initial increase of 8.3 [2.0, 14.6] (p = 0.01) but then declined to 4.9 below baseline (p = 0.3).
Conclusions:
SDR yields durable reduction in spasticity after 10 years. Early improvements in motor function are present, but at long-term follow-up, these improvements were attenuated in GMFCS II and III and were not sustained in GMFCS IV and V.
