The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children With Cerebral Palsy: A Long-term Follow-up Study
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Published on: February 2, 2024
Stacey D Miller1,2,3, Emma Lewis1, Jonathan Lau4
1BC Children's Hospital, Vancouver, BC.
Insights
Selective dorsal rhizotomy (SDR) for cerebral palsy (CP) did not increase scoliosis rates compared to the natural history of the condition. Spinal deformity risks post-SDR are linked to Gross Motor Function Classification System (GMFCS) levels, particularly higher levels.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Developmental Pediatrics
Background:
- Children with cerebral palsy (CP) face increased risks of spinal deformities, which worsen with age and higher Gross Motor Function Classification System (GMFCS) levels.
- Selective dorsal rhizotomy (SDR) is a common treatment for spasticity in CP, but its impact on spinal deformity progression requires further investigation, especially stratified by GMFCS level.
Purpose of the Study:
- To evaluate the incidence and severity of spinal deformities in children with CP at least 5 years after SDR.
- To analyze these spinal deformity risks in relation to GMFCS levels.
Main Methods:
- A retrospective review of pediatric patients who underwent SDR before 2013 at a Canadian hospital.
- Inclusion criteria required pre-operative and minimum 5-year post-SDR spinal radiographs.
- Data collected included age, GMFCS level, surgical details, and spinal deformity measurements (scoliosis, kyphosis, lordosis, spondylolisthesis).
Main Results:
- Of 107 participants (GMFCS I-V), 53% developed scoliosis post-SDR, with a mean curve of 46 degrees.
- Scoliosis prevalence and severity significantly increased with higher GMFCS levels (e.g., 92% with scoliosis at level V).
- Higher GMFCS levels (IV and V) showed increased rates of curves >40 degrees, and sagittal plane abnormalities like kyphosis and spondylolisthesis were also observed.
Conclusions:
- The rate and severity of scoliosis following SDR in children with CP are comparable to the natural progression of spinal deformities in non-surgically treated CP patients.
- Spinal deformity risk post-SDR is strongly associated with GMFCS level, highlighting the need for individualized monitoring and management strategies.
Background:
Selective dorsal rhizotomy (SDR) is commonly used to reduce spasticity in children with cerebral palsy (CP). Children with CP have an increased risk of spinal deformities that increase with age and Gross Motor Function Classification System (GMFCS) level. Few studies have considered the risk of spinal deformity post-SDR by GMFCS level. The purpose of this review was to evaluate the incidence and severity of spinal deformities in children with CP, overall and by GMFCS level, a minimum of 5 years after SDR.
Methods:
In this retrospective review, participants included all those who had an SDR before January 1, 2013, at a Canadian pediatric hospital. Participants had to have a spine radiograph preoperatively and a minimum 5 years post-SDR. Age, GMFCS level, level of laminectomy, percentage of rootlets cut, and orthopaedic surgical history were collected. Scoliosis was evaluated using coronal curve and was measured pre-SDR and a minimum 5 years post-SDR or until spine surgery. When available, sagittal plane radiographs were reviewed.
Results:
A total of 107 participants (61 male, 46 female), at GMFCS levels I to V (2,25,22,45, and 13, respectively) were included. The mean age at SDR was 4.8 years (SD 1.5), with a mean follow-up of 12.7 years (SD 4.9). Post-SDR, 57 (53%) participants had scoliosis, with the major curve averaging 46 degrees (SD 34.9). Scoliosis measuring >10 degrees was found in 8 (32%) participants at level II, 4 (18%) at level III, 33 (73%) at level IV and 12 (92%) at level V. No participants at GMFCS levels I to III, and 35% and 67% of those at levels IV and V, respectively, had a curve magnitude >40 degrees. Of those who had lateral imaging, 38% had excessive kyphosis, 21% hyperlordosis, and 16% spondylolisthesis.
Conclusions:
The rate of scoliosis is consistent with the natural history of children with CP without surgical intervention as reported in the literature when compared by GMFCS level and curve severity.
Level Of Evidence:
Level IV.
