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Published on: February 2, 2024
Predictors of outcome in patients with cerebral palsy following selective dorsal rhizotomy
Max Weinbrecht-Mischkewitz1, Elisa Wittmack1, Franziska Hentschel1
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Insights
Selective dorsal rhizotomy (SDR) outcomes in children with spastic cerebral palsy (CP) depend on age, motor function, and spasticity. Lower age and better passive range of motion predict improvement after SDR surgery.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy (CP) is a common motor disability in children.
- Selective dorsal rhizotomy (SDR) is a surgical option for managing spasticity in CP.
- Predicting outcomes of SDR is crucial for patient selection and management.
Purpose of the Study:
- To identify predictors of outcome following selective dorsal rhizotomy (SDR) in children with spastic cerebral palsy (CP).
- To utilize logistic regression models to analyze factors influencing motor function and spasticity improvement post-SDR.
Main Methods:
- Retrospective single-center study of 96 children with spastic CP who underwent SDR.
- Defined outcomes as non-improvement versus improvement in motor function and spasticity at two years post-surgery.
- Employed multivariate logistic regression to identify significant baseline predictors.
Main Results:
- Higher age at surgery and higher preoperative Gross Motor Function Measure-88 (GMFM-88) scores predicted non-improvement.
- Lower preoperative Modified Ashworth Scale (MAS) scores, higher preoperative passive range of motion (pROM), and younger age predicted motor function improvement.
- Identified pROM and preoperative spasticity as novel predictors of SDR outcome.
Conclusions:
- Preoperative passive range of motion (pROM) and spasticity levels are significant predictors of SDR success in children with CP.
- Age at surgery and baseline motor function (GMFM-88) remain important factors influencing outcomes.
- Findings aid in refining patient selection criteria for SDR, potentially improving functional outcomes.
Background:
To identify outcome predictors of selective dorsal rhizotomy (SDR) in children with spastic cerebral palsy (CP) using logistic regression models.
Methods:
A retrospective single-center study was conducted on children with spastic CP who had undergone SDR. Two outcomes were defined, one representing children not improving in motor function and spasticity and one representing children improving in motor function two years after surgery. Baseline variables were chosen based on established regressors and clinical considerations and tested for being predictors using multivariate logistic regression.
Results:
We included 96 patients (mean age [SD] 6y 9 m [2y 5 m], range 2y to 17y) in the study. Significant predictors of non-improvement in motor function and spasticity two years after SDR were higher age at surgery and higher preoperative Gross Motor Function Measure-88 (GMFM-88) score. Significant predictors of motor function improvement after SDR were lower preoperative Modified Ashworth Scale (MAS) scores, higher preoperative passive range of motion (pROM) and lower age at surgery.
Conclusions:
For the first time, pROM and preoperative spasticity were identified as predictors of SDR outcome. We confirmed motor function and age as predictors. These variables will be useful for future patient selection. Adjusting for the GMFM-88's ceiling effect, children with higher motor function can still profit significantly from SDR.
