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Published on: February 2, 2024
Selective dorsal rhizotomy long-term effects on functional motility in Jordanian children with spastic cerebral palsy
Yazan E Al-Kharabsheh1, Anas Said2, Ismail A Ismaiel2
1University of Missouri School of Medicine, Columbia, MO, United States.
Insights
Selective dorsal rhizotomy (SDR) improved motor function in Jordanian children with spastic cerebral palsy (SCP). Younger children under 10 and those with severe impairment showed the most significant gains in mobility after SDR.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy (SCP) presents significant challenges in managing motor function in children globally.
- Selective Dorsal Rhizotomy (SDR) is a surgical option for spasticity, with established benefits in functional mobility.
- SDR was introduced in Jordan in 2019, necessitating local data on its long-term efficacy.
Purpose of the Study:
- To assess the long-term effects of Selective Dorsal Rhizotomy (SDR) on motor function in Jordanian children with spastic cerebral palsy (SCP).
- To identify optimal patient characteristics and therapeutic windows for SDR in this population.
Main Methods:
- A retrospective cohort study analyzed 43 Jordanian children (mean age 6.2 years) who underwent SDR between 2019 and 2023.
- Gross Motor Function Classification System (GMFCS) and Functional Mobility Scale (FMS) scores were compared pre- and 12-months post-SDR.
- Statistical analysis included age, sex, GMFCS/FMS scores, and post-SDR treatments.
Main Results:
- Significant improvements in GMFCS and FMS scores were observed 12 months after SDR (p < 0.001).
- Children younger than 10 years and those with severe impairment (GMFCS levels IV-V) demonstrated greater GMFCS score reductions.
- Functional improvements were comparable between sexes; physiotherapy continued, Botox use decreased, and adjunct orthopedic surgeries increased post-SDR.
Conclusions:
- SDR offers significant long-term benefits for functional mobility in children with spastic cerebral palsy (SCP).
- Younger children (<10 years) and those with higher GMFCS scores are identified as potentially better candidates for SDR.
- These findings are crucial for optimizing SDR candidate selection and timing in Jordan.
Introduction:
Spasticity management in children with cerebral palsy (CP) is a challenge for healthcare providers worldwide. In the US and Europe, treatment options include non-surgical and surgical (i.e., selective dorsal rhizotomy, SDR) procedures, with beneficial effects on functional motility. SDR was introduced in Jordan in 2019. We performed the first assessment of the long-term effects on motor function in Jordanian children with spastic CP (SCP) who underwent SDR.
Methods:
A retrospective cohort study of 43 patients (28 boys, 15 girls, mean ± SD age at surgery, 6.2 ± 2.5 years, 67.4% with diplegia, 30.2% quadriplegia, and 2.3% hemiplegia, 97.7% bilateral deficits) who received SDR (42 bilateral) was conducted between 01/01/2019 and 03/01/2023. Gross Motor Function Classification System (GMFCS) and Functional Mobility Scale (FMS) scores were compared before and 12 months after SDR. Sex, age and clinical scores at surgery, and post-SDR surgical treatment were included in the model (IBM SPSS Statistics 29.0).
Results:
Clinical scores improved 12 months after SDR: GMFCS decreased by at least one level (in 58.5% of patients), and FMS significantly increased (p < 0.001); GMFCS decreased in 77.7% of those with pre-SDR severe impairment vs. 43.5% in moderately to mildly impaired patients. An age sub-analysis demonstrated higher changes in GMFCS in younger children (GMFCS decreased in 46.9% of those aged <10 years old vs. none in those older than 10 years). These findings suggest that younger children (<10 years old) and more impaired (levels IV and V on GMFCS) are likely the best candidates for this procedure. Twelve-month functional improvement was similar in boys and girls (GMFCS decreased in 44.0% of boys vs. 37.5% of girls). Compared to pre-SDR management, all patients continued physiotherapy, less received Botox (by 97.7%), and more received adjunct orthopedic surgeries (32.6% vs. none) after SDR; out of those receiving post-SDR adjuvant surgeries, 50.0% improved GMFCS (compared to 64.0% of those without).
Conclusion:
Our data demonstrated SDR's beneficial long-term effects on functional mobility in SCP children, particularly those younger than 10 years and more severely impaired. These findings provide critical information that may aid in identifying "the best" therapeutic window and "the best" candidate for SDR in Jordan.
