Effect of selective dorsal rhizotomy on need for orthopedic surgery for spastic quadriplegic cerebral palsy: long-term outcome analysis in relation to age

O’Brien, Donncha F.; Park, Tae Sung; Puglisi, Joan A; Collins, David R.; Leuthardt, Eric C.

doi:10.3171/ped.2004.101.2.0059

Cited by 17 publications

(20 citation statements)

References 25 publications

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“…10 Both the measure GMFM, and the classification GMFCS, have been found to be valid and reliable tools that are widely used in clinical work and research involving children with CP. The GMFM is frequently used to evaluate the effects of various interventions in children with CP, such as intensive physiotherapy, [11][12][13][14] botulinum toxin treatment, 15 selective dorsal rhizotomy, 16 and orthopaedic surgery. [17][18][19] The GMFM is a test specially designed and validated for measuring gross motor function and the change over time in children with CP.…”

mentioning

confidence: 99%

The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years

Beckung

Carlsson²,

Carlsdotter

et al. 2007

Develop Med Child Neuro

151

103

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The aim of this study was to explore motor development in children with cerebral palsy (CP) using developmental curves for CP, subtypes, and the five severity levels of the Gross Motor Function Classification System (GMFCS). The Gross Motor Function Measure (GMFM) and the GMFCS were applied to 317 children (145 females, 172 males) with CP, aged between 1 and 15 years. The CP type distribution was spastic diplegia in 157 (49%), spastic hemiplegia in 101 (33%), spastic tetraplegia in 11 (3%), dyskinesia in 38 (12%), and ataxia in 10 (3%). Forty‐five physiotherapists were trained in the GMFM and intra‐ and interrater reliability was tested. The GMFM was measured prospectively every 6 months up to the age of 4 years and once a year thereafter. Developmental curves were constructed for 258 children with spastic CP. About three‐quarters of the children at GMFCS Level I reached 90% of the maximum GMFM score at 5 years of age. The performance peaked at 7 years of age. Children at GMFCS Level II reached 90% at a median age of 5 years, which was also the upper limit, reached by about three‐quarters at 7 years of age. The majority of children at GMFCS Level III reached 80% of the GMFM by 7 years of age and most of the children at GMFCS Level IV reached 30% at 5 years and remained there. The median score for children at GMFCS Level V was 20%. The intra‐ and interrater reliability for the GMFM 88 among physiotherapists were Spearman's rank correlation coefficient 0.91 and 0.99 respectively. There were 931 measurements with a median of 2 (1–11) per child. The gross motor development was demonstrated for the five GMFCS levels in children with spastic CP. These kind of curves may be useful for monitoring and predicting motor development, for planning treatment, and for evaluating outcome after interventions.

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mentioning

confidence: 99%

The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years

Beckung

Carlsson²,

Carlsdotter

et al. 2007

Develop Med Child Neuro

151

103

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“…A significant decrease in spasticity and range of motion was found was found 5 years after SDR in four studies 10,18,19,21 and in one study 20 years after SDR 14 . One Level IV study reported a significant improvement of gait performance in a subgroup of children that have been younger than 5 years old when SDR was performed 23 . There was no association between the age at the operation and outcome in any of the other studies.…”

Section: Discussionmentioning

confidence: 86%

“…However, the results in the body function and structure domain were not mentioned separately for the patients in the control group. Six further Level IV studies including 244 patients reported outcomes in the domain of body structure and body function 10,14,18,21,23,25 . A significant decrease in spasticity and range of motion was found was found 5 years after SDR in four studies 10,18,19,21 and in one study 20 years after SDR 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Long-term influence on ICF activity and participation domains and risk of spinal anomalies after SDR remain uncertain. The level of evidence produced by these studies was poor to moderate with 18 Level IV studies [8][9][10][11][13][14][15][16][17][18][20][21][22][23][24][25][26] unable to evaluate causation and three Level III studies 12,19,27 able to provide tentative conclusions that the outcomes were attributable to the SDR.…”

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confidence: 99%

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Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

Grunt

Becher

Vermeulen

2011

Developmental Medicine &Amp; Child Neurology

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“…For this review we focused on three previous reports from our department in which the relationships between orthopedic surgery and SDR were explored. 3,12,13 Our review is subdivided into four parts to address these three reports and also the need for spinal stabilization after SDR.…”

Section: Orthopedic Surgery Post-sdr: Objectives Of the Reviewmentioning

confidence: 99%

A review of orthopedic surgeries after selective dorsal rhizotomy

O’Brien¹,

Park²

2006

Neurosurgical Focus

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✓ Selective dorsal rhizotomy (SDR) is an evidence-based treatment for cerebral palsy (CP) spasticity. During their lifetime, patients with CP spasticity may require orthopedic surgery for muscles and joints to correct physical deformities and provide a better quality of life. In this review, the authors discuss the timing of such orthopedic surgery, its necessity, and whether it is influenced by the performance of SDR. A review of findings from the authors' 19 years of experience yields the following conclusions: 1) that SDR reduces orthopedic surgery requirements when compared with historical controls; 2) that SDR performed in patients at a young age (2–4 years) can reduce future orthopedic surgery requirements; 3) that independent walkers and diplegic patients will have the smallest amount of orthopedic surgery post-SDR; and 4) that patients who need assistance walking and those with quadriplegia will have the greatest amount, although the frequency of orthopedic surgery for quadriplegic patients is not as high as popularly believed.

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Effect of selective dorsal rhizotomy on need for orthopedic surgery for spastic quadriplegic cerebral palsy: long-term outcome analysis in relation to age

Abstract: The results of this study highlight the effect of SDR on gait status in children with spastic quadriplegic cerebral palsy. The percentage of patients needing orthopedic operations was not as high as reported previously. Parents indicated that SDR was beneficial to their children.

Cited by 17 publications

References 25 publications

The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years

The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years

Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

A review of orthopedic surgeries after selective dorsal rhizotomy

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