Long‐term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case–control study

Abstract

Aim Selective dorsal rhizotomy (SDR) is a surgical treatment for spasticity in children with cerebral palsy (CP). Studies suggest long-lasting effects of SDR on spasticity; long-term effects on symptoms and function are not clear. This study tested whether adults with CP (average 22y after SDR) report less pain, fatigue, and functional decline than a retrospectively assessed non-surgical comparison group. Method This was a case–control study. Eighty-eight adults with CP (mean age 27y 0mo; SDR=38; non-surgical [comparison]=50) recruited from a tertiary care center and the community completed a battery of self-reported outcome measures. Regression models were used to test whether SDR status predicted pain, fatigue, functional change, and hours of assistance (controlling for Gross Motor Function Classification System level). Results SDR status did not significantly predict pain interference (p=0.965), pain intensity (p=0.512), or fatigue (p=0.404). SDR related to lower decline in gross motor functioning (p=0.010) and approximately 6 fewer hours of daily assistance than for those in the comparison group (p=0.001). Interpretation Adults with CP who had SDR in childhood reported less gross motor decline and fewer daily assistance needs than non-surgically treated peers, suggesting the functional impact of SDR persists long after surgery.

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

“…One study had controls of comparable age, but the SDR and comparison group were significantly different with respect to Gross Motor Function Classification System (GMFCS) level. Moreover, the comparison group included individuals with all subtypes of CP, even subtypes purposely excluded from SDR intervention, such as dyskinetic and unilateral CP . In the other investigation with a control group, Munger et al made retrospective comparisons (indicated by a propensity model to be highly accurate) to individuals whose clinical presentation was appropriate for SDR, but who, for a variety of reasons, did not undergo surgery .…”

“…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.…”

“…The level of fatigue reported by patients who had undergone SDR was similar to that of a comparison group in one investigation. 6…”

“…Moreover, the comparison group included individuals with all subtypes of CP, even subtypes purposely excluded from SDR intervention, such as dyskinetic and unilateral CP. 6 In the other investigation with a control group, Munger et al made retrospective comparisons (indicated by a propensity model to be highly accurate) to individuals whose clinical presentation was appropriate for SDR, but who, for a variety of reasons, did not undergo surgery. 17 In one study, the use of validated motor development charts for long-term assessment of gross motor function after SDR allowed comparison with the manner in which a child with CP is expected to develop.…”

Surgical Treatment for Spasticity: Selective Dorsal Rhizotomy – Technique and Literature Review

“…Concluíram que o grupo RDS apresentou menos dor, fadiga e declínio funcional comparado com o grupo não-cirúrgico. 40 A técnica de RDS por laminoplastia de segmento único fornece uma abordagem menos invasiva e a incidência de escoliose após esta abordagem é comparável com a história natural de crianças acompanhado ambulatoriamente. 41…”