Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study

Abstract

Purpose Assess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory). Methods This is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3–18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores. Results Between 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7–3.1, p < 0.001, annual change 1.2 units). Of the 67 patients with a GMFM-66 measurement available, a documented increase in gross motor function was seen in 77.6% (n = 52). Of 101 patients with spasticity data available, mean Ashworth scale decreased after surgery (2.74 to 0.30). Of patients’ pain scores, 60.7% (n = 34) improved, and 96.4% (n = 56) of patients’ pain scores remained the same or improved. Bladder function improved in 30.9% of patients. Conclusions SDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients.

Before selective dorsal rhizotomy can be judged as beneficial for cerebral palsy, long-term results and controlled studies are needed

“…Therefore, it was concluded that aggressive spasticity treatment by SDR does not result in significant differences in gait kinematics in individuals with cerebral palsy in young adulthood compared to minimal spasticity treatment ( 2 ). However, the results of SDR may differ between ambulatory and nonambulatory patients ( 3 ). It is also conceivable that unsupervised machine learning methods can effectively and accurately classify patients into different subgroups suffering from cerebral palsy based on preoperative characteristics, and improve outcome after SDR through better selection ( 4 ).…”