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Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study
Conor S Gillespie1,2,3, Benjamin J Hall4, Alan M George4
1Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK. gilles@liverpool.ac.uk.
Insights
Selective dorsal rhizotomy (SDR) improved gross motor function and reduced pain in non-ambulatory children with cerebral palsy. While benefits were less pronounced than in ambulatory groups, SDR is a viable option for improving quality of life.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Spastic diplegic cerebral palsy significantly impacts motor function in non-ambulatory children (GMFCS IV-V).
- Selective dorsal rhizotomy (SDR) is a surgical intervention aimed at reducing spasticity and improving motor control.
- Assessing SDR's efficacy in severely affected pediatric populations is crucial for treatment guidance.
Purpose of the Study:
- To evaluate the impact of SDR on gross motor function in children with GMFCS levels IV-V.
- To assess changes in spasticity, bladder function, quality of life, and pain following SDR.
- To compare outcomes in non-ambulatory children with those in less affected GMFCS levels.
Main Methods:
- Prospective observational study across three UK neurosurgery units (2012-2019).
- Included 144 children (aged 3-18) with spastic diplegic cerebral palsy (GMFCS IV-V).
- Primary outcome: change in Gross Motor Function Measure (GMFM-66) at 24 months; secondary outcomes: spasticity (Ashworth Scale), bladder function, quality of life, pain.
Main Results:
- Mean GMFM-66 score increased by 2.4 units at 24 months post-SDR (p < 0.001), with 77.6% showing improvement.
- Significant reduction in spasticity (Ashworth Scale mean decrease from 2.74 to 0.30).
- Pain improved or remained stable in 96.4% of patients; bladder function improved in 30.9%.
Conclusions:
- SDR demonstrates significant benefits in gross motor function and pain reduction for non-ambulatory children with cerebral palsy.
- Outcomes, while positive, are less pronounced compared to children with GMFCS levels II-III.
- SDR should be considered as a therapeutic option for improving functional outcomes and quality of life in severely affected non-ambulatory children.
Purpose:
Assess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory).
Methods:
This is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3-18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores.
Results:
Between 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7-3.1, p < 0.001, annual change 1.2 units). Of the 67 patients with a GMFM-66 measurement available, a documented increase in gross motor function was seen in 77.6% (n = 52). Of 101 patients with spasticity data available, mean Ashworth scale decreased after surgery (2.74 to 0.30). Of patients' pain scores, 60.7% (n = 34) improved, and 96.4% (n = 56) of patients' pain scores remained the same or improved. Bladder function improved in 30.9% of patients.
Conclusions:
SDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients.
