Background Selective dorsal rhizotomy (SDR) is an irreversible surgical procedure involving the division of selected sensory nerve roots, followed by intensive physiotherapy. The aim is to improve function and quality of life in children with cerebral palsy and a Gross Motor Function Classification System (GMFCS) level of II or III (walks with or without assistive devices, respectively). We assessed gross motor function before and after SDR and postoperative quality of life in a study commissioned by NHS England. MethodsWe did a prospective observational study in five hospitals in England who were commissioned to perform SDR on children aged 3-9 years with spastic diplegic cerebral palsy. The primary outcome was score changes in the 66-item Gross Motor Function Measure (GMFM-66) and seven domains of the Cerebral Palsy Quality of Life Questionnaire ([CP-QoL] social wellbeing and acceptance, feelings about functioning, participation and physical health, emotional wellbeing and self-esteem, access to services, family health, and pain and impact of disability) from before to 24 months after SDR. Findings From Sept 4, 2014, to March 21, 2016, 137 children underwent SDR. The mean age was 6•0 years (SD 1•8).The mean GMFM-66 score increased after SDR with an annual change of 3•2 units (95% CI 2•9 to 3•5, n=137). Of the seven CP-QoL domains, five showed significant improvements over time: feelings about functioning mean annual change 3•0 units (95% CI 2•0 to 4•0, n=133), participation and physical health 3•9 units (2•5 to 5•3, n=133), emotional wellbeing and self-esteem 1•3 units (0•2 to 2•3, n=133), family health 2•0 units (0•7 to 3•3, n=132), and pain and impact of disability -2•5 units (-3•9 to -1•2, n=133). 17 adverse events were reported in 15 children, of which none were severe and 15 (88%) resolved.Interpretation SDR improved function and quality of life in the 24 months after surgery in children with cerebral palsy classified as GMFCS levels II and III. On the basis of these findings, an interim national policy decision was made that SDR would be funded for eligible children in England from 2018.
The management of cerebral palsy (CP) is complex and requires a multidisciplinary approach. Selective dorsal rhizotomy (SDR) is a neurosurgical technique that aims to reduce spasticity in the lower limbs.A minimally invasive approach to SDR involves a single level laminectomy at the conus and utilises intraoperative electromyography (EMG). When combined with physiotherapy, SDR is effective in selected children and has minimal complications. This review discusses the epidemiology of CP and the management using SDR within an integrated multidisciplinary centre. Particular attention is given to the single-level laminectomy technique of SDR and its rationale, and the patient workup, recovery and outcomes of SDR.
Background Selective dorsal rhizotomy (SDR) is an irreversible neurosurgical procedure used to reduce spasticity while aiming to improve gross motor function for children with cerebral palsy (CP). Little research has explored the complexity of parental decision‐making experiences surrounding SDR surgery and required rehabilitation. The aim was to explore parental experiences and expectation in the decision‐making process around the SDR operation, physiotherapy treatment and outcomes. Method Qualitative methods using in‐depth, semi‐structured interviews were used. Eighteen parents (11 mothers and 7 fathers) participated whose child had SDR and completed 2‐year post‐operative rehabilitation. Data were analysed using thematic analysis. Results Decision making involved an interacting process between the ‘parental information seeking experience’, ‘influence of professional encounters and relationships’ and ‘emotional and social aspects’. Despite underlying uncertainties about outcomes, parental drivers of expectations and aspirations for their child preceded and sustained this decision‐making process. A foundational narrative of ‘wanting no regrets’ resolved their decision to undertake SDR. Outcomes did not always match expectations, and parents moved away from a position of idealism, which was driven in part by parental information seeking including overly optimistic media representation. Conclusion Universally, parents expressed they had ‘no regrets’ on their decision, yet many felt a mismatch between expectation and outcomes of SDR surgery. A greater understanding of the complex nature of SDR decision making is required to help improve family preparedness and provide support from clinicians to enable balanced discussions in parental decision‐making.
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