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Orthopedic surgery after selective dorsal rhizotomy in children with cerebral palsy: A matched cohort study
Michael H Schwartz1,2, Andrew G Georgiadis1,2
1Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
Insights
Selective dorsal rhizotomy (SDR) in children with cerebral palsy did not consistently reduce orthopedic surgery rates. While some surgeries decreased, others, including those for muscle contractures, were unaffected by SDR.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Pediatric Orthopedics
Background:
- Selective dorsal rhizotomy (SDR) is a neurosurgical procedure used in managing spasticity in children with cerebral palsy (CP).
- The impact of SDR on the long-term need for subsequent orthopedic surgeries in this population is not fully understood.
Purpose of the Study:
- To investigate whether selective dorsal rhizotomy (SDR) influences the incidence of subsequent orthopedic surgical procedures in children diagnosed with cerebral palsy (CP).
Main Methods:
- A matched cohort study design was employed using historical data from a single institution.
- Two groups, SDR (yes-SDR) and no-SDR, were matched on baseline clinical variables.
- Kaplan-Meier estimates were used to determine the cumulative incidence of 10 defined orthopedic surgery categories, stratified by SDR status.
Main Results:
- Foot and ankle bone surgery and femoral derotation osteotomy showed a 15% to 20% higher cumulative incidence post-SDR.
- Rectus femoris transfer demonstrated a notable decrease in cumulative incidence (approximately 30%) following SDR.
- Surgeries for muscle contractures and other procedures showed no significant difference in cumulative incidence (p > 0.05).
Conclusions:
- Selective dorsal rhizotomy (SDR) does not consistently reduce the overall incidence of orthopedic surgery in children with cerebral palsy.
- SDR does not appear to lower the rate of surgery specifically for managing muscle contractures.
- Further research is needed to elucidate the mechanisms by which SDR affects the need for subsequent orthopedic interventions.
Aim:
To test whether selective dorsal rhizotomy (SDR) changes the incidence of subsequent orthopedic surgery in children with cerebral palsy.
Method:
This was a matched cohort study. Using historical data from a single center, we identified two groups of individuals based on their history of SDR (yes-SDR and no-SDR), matched at baseline on key clinical variables. We defined 10 orthopedic surgery categories that accounted for more than 95% of surgery recorded in our gait center database. We then fitted Kaplan-Meier estimates of cumulative incidence for each surgery, stratified according to SDR status.
Results:
We obtained excellent comprehensive baseline matching. Foot and ankle bone surgery and femoral derotation osteotomy exhibited 15% to 20% higher cumulative incidence after SDR. Rectus femoris transfer exhibited approximately 30% lower cumulative incidence after SDR. The remaining surgeries, including all surgeries for treating muscle contractures, were unaffected by SDR, exhibiting only small (<15%) or nonsignificant (p > 0.05, log-rank test) differences in cumulative incidence.
Interpretation:
SDR does not consistently lower the cumulative incidence of orthopedic surgery and does not lower the rate of surgery for muscle contracture. The mechanisms through which SDR influences subsequent surgery remain unclear, highlighting a critical area for future research.
