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Updated: Oct 14, 2025
Enhancing the Development and Growth of Infant Cerebral Palsy Rats Using Selective Spinal Manipulations
Published on: February 2, 2024
Long-term effects of spasticity treatment, including selective dorsal rhizotomy, for individuals with cerebral palsy
Bruce A MacWilliams1,2, Mark L McMulkin3, Elizabeth A Duffy4
1Shriners Hospitals for Children, Salt Lake City, UT, USA.
Insights
Selective dorsal rhizotomy (SDR) effectively reduced spasticity long-term in cerebral palsy patients. While other outcomes were similar, SDR improved gait deviation and walking speed, suggesting its long-term benefits.
Area of Science:
- Neurology
- Orthopedics
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy significantly impacts motor function and quality of life.
- Long-term effects of comprehensive spasticity management, including selective dorsal rhizotomy (SDR), require further investigation.
Purpose of the Study:
- To evaluate the long-term effects of spasticity treatment, specifically including SDR, on individuals with spastic cerebral palsy.
- To compare outcomes between patients who underwent SDR and those who did not.
Main Methods:
- A multicenter, retrospectively matched cohort study comparing patients with (Yes-SDR) and without (No-SDR) SDR.
- Long-term assessments (≥10 years follow-up, age ≥21) included spasticity, contractures, gait, strength, function, and quality of life.
Main Results:
- Spasticity was significantly reduced in the Yes-SDR group but unchanged in the No-SDR group at long-term follow-up.
- No meaningful differences were observed in most measures, except for improved Gait Deviation Index and preserved walking speed in the Yes-SDR group.
- The Yes-SDR group received more orthopedic surgeries and lower limb antispastic injections.
Conclusions:
- Comprehensive spasticity treatment including SDR leads to long-term spasticity reduction and improved gait parameters in cerebral palsy.
- Untreated spasticity did not result in significant long-term impairments in pathophysiology, function, or quality of life in this cohort.
Aim:
To understand the long-term effects of comprehensive spasticity treatment, including selective dorsal rhizotomy (SDR), on individuals with spastic cerebral palsy.
Method:
This was a pre-registered, multicenter, retrospectively matched cohort study. Children were matched on age range and spasticity at baseline. Children at one center underwent spasticity treatment including SDR (Yes-SDR, n=35) and antispastic injections. Children at two other centers had no SDR (No-SDR, n=40 total) and limited antispastic injections. All underwent subsequent orthopedic treatment. Participants returned for comprehensive long-term assessment (age ≥21y, follow-up ≥10y). Assessment included spasticity, contracture, bony alignment, strength, gait, walking energy, function, pain, stiffness, participation, and quality of life.
Results:
Spasticity was effectively reduced at long-term assessment in the Yes-SDR group and was unchanged in the No-SDR group. There were no meaningful differences between the groups in any measure except the Gait Deviation Index (Yes-SDR + 11 vs No-SDR + 5) and walking speed (Yes-SDR unchanged, No-SDR declined 25%). The Yes-SDR group underwent more subsequent orthopedic surgery (11.9 vs 9.7 per individual) and antispastic injections to the lower limbs (14.4 vs <3, by design).
Interpretation:
Untreated spasticity does not cause meaningful impairments in young adulthood at the level of pathophysiology, function, or quality of life.
