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Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively
I Hodgkinson1, C Bérard, M L Jindrich
1Escale-Service de rééducation fonctionnelle pédiatrique, Centre Hospitalier Lyon-Sud, Lyon, France.
Insights
Selective dorsal rhizotomy (SDR) reduced spasticity in children with cerebral palsy, improving some motor functions. However, it did not prevent orthopedic issues, though families reported high satisfaction.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy (CP) significantly impacts motor skill acquisition and can lead to orthopedic complications.
- Selective Dorsal Rhizotomy (SDR) is a surgical intervention aimed at reducing spasticity in CP.
- Assessing the comprehensive effects of SDR on both orthopedic and functional outcomes is crucial for treatment optimization.
Purpose of the Study:
- To evaluate the orthopedic and functional effects of Selective Dorsal Rhizotomy (SDR) in children with spastic cerebral palsy.
- To determine the impact of SDR on spasticity, range of motion, hip migration, and functional motor abilities.
- To assess patient and family satisfaction following SDR surgery.
Main Methods:
- A prospective study design comparing outcomes before and 1 year after SDR in 18 children with spastic quadriplegic CP.
- Standardized assessments included spasticity scales, range of motion, hip migration radiography, Gross Motor Function Measure (GMFM), and the Abbott scale.
- All participants underwent 6 months of intensive postoperative physiotherapy, with assessments conducted by a single physiotherapist.
Main Results:
- SDR led to a decrease in spasticity across all muscle groups and improved hip range of motion (abduction and extension).
- No significant changes were observed in hip migration, and the Gross Motor Function Measure (GMFM) score increased by 3.2%.
- One child improved functional classification on the Abbott scale, and 16 families reported high satisfaction; 3 children still required planned orthopedic surgery.
Conclusions:
- While SDR effectively reduces spasticity and improves certain functional aspects in children with spastic quadriplegic CP, it does not eliminate the risk of orthopedic complications.
- Improvements in qualitative function post-SDR may exceed the sensitivity of current assessment tools.
- SDR offers significant benefits in managing spasticity and enhancing functional capabilities, contributing to high patient satisfaction.
Objective:
Effects of selective dorsal rhizotomy (SDR) were studied in children with spastic cerebral palsy in orthopaedic and functional fields.
Methods:
In a prospective study, we compared the same population before SDR and 1 year after SDR. This population included children with spastic cerebral palsy, when spasticity was responsible for a halt in the motor skill acquisitions or for orthopaedic complications. All the children had intensive physiotherapy for 6 months postoperatively. We observed spasticity by a 4-point scale, isolation of movement by a 3-point scale, and orthopaedic status by the measure of range of motion, hip migration on the radiography, and function by Gross Motor Function Measure (GMFM) and Abbott scale. All the assessments were done by the same physiotherapist. We compared the results with a Wilcoxon statistic test.
Results:
18 quadriplegic children had spastic cerebral palsy; their mean age was 9 years (5.5-16.5 years). We observed a decrease in spasticity in all the muscular groups; increase in range of motion only on abduction and extension of the hips; no evolution of hip migration; an increase of 3.2% in the total GMFM score; 1 child was classified IV before SDR and V after SDR on the Abbott scale; 3 children had planned orthopaedic surgery in the year after SDR; 16 children and their families were highly satisfied with the result of the surgery.
Conclusions:
The decrease in spasticity does not entail prevention of orthopaedic problems in children with quadriplegic spastic cerebral palsy. However, we observed an improvement in qualitative function that is outside the scope of current assessment scales.