A prospective cohort study investigating gross motor function, pain, and health‐related quality of life 17 years after selective dorsal rhizotomy in cerebral palsy

Abstract

ROMRange of motion SDR Selective dorsal rhizotomy AIM The aim of this study is to evaluate the long-term effects of selective dorsal rhizotomy (SDR), 15 to 20 years after surgery in patients with cerebral palsy.METHOD Eighteen children (four females, 14 males; mean age at SDR 4y 7mo, SD 1y 7mo) with bilateral spastic cerebral palsy (CP), were prospectively assessed after SDR. This study focuses on the outcome 15 to 20 years after the procedure. The assessments include the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure (GMFM-88), the Wilson Mobility Scale, The Health-Related Quality of Life Health Survey, SF-36v2, and the Brief Pain Inventory. RESULTSThe effect of normalized muscle tone in lower extremities after SDR was sustained after a median of 17 years. The best gross motor function capacity, according to the GMFM score, was seen at the 3-year follow-up, thereafter a gradual decline followed. Half of the individuals reported low intensity pain and interference. Compared to a norm sample the physical health component of SF-36v2 was slightly lower and the mental health component slightly higher. INTERPRETATIONThe spasticity-reducing effect of SDR does not improve long-term functioning, nor prevent contractures, but it can possibly reduce the pain often experienced by individuals with CP.Selective dorsal rhizotomy (SDR) has been regularly used for more than two decades in order to alleviate lower limb spasticity in children with cerebral palsy (CP). Results have displayed a reduction in both short-and long-term spasticity (i.e. beneficial effects at the body function/structure domain when the International Classification of Functioning, Disability and Health [ICF] 1 is used as a frame of reference).2-4 The muscle tone decrease has been shown to be stable for up to 10 years. [5][6][7][8] Nonetheless, there is currently no evidence that SDR has any positive long-term effects on the ICF activity and participation domains where changes in, for example, gross motor function will be assigned. 2,3,9 Other than spasticity (which is commonly evaluated in SDR studies) earlier studies have focused on evaluating a limited number of factors; ROM, gait, gross motor function and the need of orthopaedic surgery. There is a possibility that spasticity reduction after SDR might affect other features such as physical activity, health-related quality of life, and pain.We have previously published a report where 19 children were followed up for 10 years after SDR. 8 We concluded that 10 years after SDR, the spasticity-reducing effect was maintained, but this did not seem to improve long-term functioning or prevent contractures in this group of children with spastic diplegic CP. This suggests that contractures development in CP is not only mediated by spasticity'. We also proposed that other possible effects of spasticity reduction should be addressed in future research.Our present study evaluates the same cohort of young persons with CP with the aim to establish if the spasticity reduction was still pres...

Long‐term outcomes after selective dorsal rhizotomy: a retrospective matched cohort study

“…Our study participants reported that pain caused only a minimal interference with activities. Tedroff et al reported similar results, but, owing to lack of a control group, concluded this benefit may be due to the SDR . Our study suggests alternative treatment regimens equally prevent the onset of pain through early adulthood.…”

“…Long‐term studies up to 26 years post‐SDR suggest that many important outcomes peak 1 to 3 years after surgery . This peak has been shown for gross motor function (Gross Motor Function Measure), ambulatory status (Wilson Mobility Scale), ankle ROM, and popliteal angle.…”

“…Despite a regression of these measures over the long term, other outcomes such as hip and knee ROM, cadence, and step length have been shown to improve from baseline. Additionally, pain has been reported as low severity and having minimal interference with general activities . In a cohort of individuals aged 17 to 26 years after SDR, gross motor function was shown to be maintained or to improve, although the strength of these claims is limited by the utilization of a subjective retrospective determination of Gross Motor Function Classification System (GMFCS) values .…”

Forearm Flexor Muscles in Children with Cerebral Palsy Are Weak, Thin and Stiff

“…Due to the fact that many children with spastic CP eventually develop skeletal muscle contractures, spasticity has been believed to be causative and clinical practice has up until recently been focused on spasticity reducing therapies for the preservation of motor function. However, recent reports have clearly demonstrated that despite good control of spasticity and reduction of muscle tone, by intramuscular botulinum toxin injections (chemical denervation) or selective dorsal rhizotomy that disrupts the reflex loop, skeletal muscle contracture formation progresses (Alhusaini et al, 2011; Tedroff et al, 2014). The poor effect of spasticity reduction on contracture development has raised the question of whether other factors such as growth disturbances and/or alterations in muscle composition are of greater mechanistic importance.…”

The role of visual stimuli on standing posture in children with bilateral cerebral palsy

“…For example, one study reports that spasticity was found only minimally relates to gross motor function in children with bilateral CP [10]. Likewise, studies evaluating gross motor function before and after muscle tone reduction have shown no or limited functional gains despite spasticity reduction [11, 12]. In a previous study, we found that neither spasticity nor contractures could determine the need for support to stand in children with bilateral CP [4].…”