Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later

Abstract

BackgroundSelective dorsal rhizotomy (SDR) is a surgical method used to treat childhood spastic cerebral palsy (CP). However, the effects of early SDR on functional outcomes and quality of life decades later in adulthood remains to be elucidated.ObjectivesTo evaluate the long-term outcomes in terms of satisfaction and mobility of adult patients who received childhood SDR.MethodsAdult patients who received SDR in childhood were surveyed. The survey questionnaire asked about demographic information, quality of life, health outcomes, SDR surgical outcomes, ambulation, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, and work status.ResultsOur study included 95 patients. The age that patients received SDR was between two and 18 years. The age at the time of survey was between 23 and 37 years (mean ± S.D., 30.2 ± 3.6 years). Post-SDR follow-up ranged from 20 to 28 years (mean ± S.D., 24.3 ± 2.2 years). Seventy-nine percent of patients had spastic diplegia, 20% had spastic quadriplegia, and one percent had spastic triplegia. Ninety-one percent of patients felt that SDR impacted positively the quality of life and two percent felt that the surgery impacted negatively the quality of life after SDR. Compared to pre-operative ambulatory function, 42% reported higher level of ambulation and 42% ambulated in the same level. Eighty-eight percent of patients would recommend the procedure to others and two percent would not. Thirty-eight percent reported pain, mostly in the back and lower limbs, with mean pain level 4.2 ± 2.3 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in patchy areas of the lower limbs that did not affect daily life was reported by eight percent of patients. Scoliosis was diagnosed in 31%. The severity of scoliosis is unknown. Only three percent of them underwent spinal fusion. Fifty-seven percent of patients required some orthopedic surgery after SDR. The soft-tissue tendon lengthening procedures included lengthening on hamstrings, Achilles tendons or adductors. Out of all bone procedures, 24% of patients had hip surgery, five percent had knee surgery, and 10% had derotational osteotomies. No late side effects of SDR surgery were reported in this survey.ConclusionsIn our 95 adult patients who received SDR in childhood, the surgery had positive effects on the quality of life and ambulation 20-28 years later. There were no late complications of SDR surgery.

Long‐term effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

“…Munger et al documented an average of 7.5 and 19 BoNT‐A injections in the SDR and comparison groups respectively . Finally, Park et al reported that 22% of their participants still required oral antispasticity medication and 3% were treated with intrathecal baclofen at long‐term follow‐up …”

“…Included studies for outcome of SDR at 10 years or more After removing duplicates, 199 articles were screened and 16 included [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table II and Fig. S1); none involved a randomized control trial nor prospective evaluation of a control group.…”

“…Park et al reported improved ambulation in 42% of participants' gait, similar to the preoperative situation in 42%, and worsened ambulation in 14%. 18 Tedroff et al reported improvement in short-term ambulatory status, followed by a decline to baseline levels at 10 and 17 years' follow-up. 20,21 Self-care and mobility…”

Long-term results of chronic intrathecal baclofen treatment in patients with spasticity and secondary dystonia

“…В связи с отсутствием значимой разницы между двигательным развитием ребенка с ДЦП в 9 лет и в более старшем возрасте мы посчитали возможным использовать шкалу GMFM-88 у больных старше 16 лет. Этот методологический прием также использовался другими авторами при оценке пациентов в послеоперационном периоде [8,9].…”

No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

“…Spondylolisthesis was uncommon preoperatively and postoperative prevalence ranged from 2-27%, mainly minor to grade 1 slippage (4,5,7,(9)(10)(11). In a 20-28-year follow-up after SDR, Park et al found 31% with scoliosis and other spinal problems (12).…”