Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy

Ailon, Tamir; Beauchamp, Richard; Miller, Stacey; Mortenson, Patricia; Kerr, J. M. Munro; Hengel, Alexander R.; Steinbok, Paul

doi:10.1007/s00381-015-2614-9

Cited by 62 publications

(58 citation statements)

References 22 publications

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“…Seven out of the 16 studies evaluated the effect on spasticity specifically, and all reported sustained long‐term reduction or even normal muscle tone …”

Section: Resultsmentioning

confidence: 99%

“…With respect to the duration of the reduction in spasticity after SDR, only seven of the 16 studies analysed took a long‐term perspective . A sustained reduction of spasticity in most of the muscles evaluated was most often reported.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, in earlier times medical records were often somewhat unspecific and/or subjective, including vague descriptions (such as ‘moderately affected’ or ‘severe type’) of function and severity, precluding retrospective assignment of GMFCS levels. Nevertheless, many of the relevant studies published to date have assigned baseline GMFCS levels retrospectively when evaluating the outcome of SDR performed in the early 1980s and throughout the 1990s . Such an approach can introduce a substantial risk of detection bias, especially when changes in GMFCS level are used as a measure of outcome.…”

Section: Discussionmentioning

confidence: 99%

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

Tedroff

Hägglund

Miller

2019

Develop Med Child Neuro

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Aim To evaluate the long‐term effects of selective dorsal rhizotomy (SDR) 10 years or more after the procedure and complications observed any time after SDR in children with cerebral palsy (CP). Method Embase, PubMed, and the Cochrane Library were searched from their individual dates of inception through 1st June 2018 for full‐text original articles in English that described long‐term follow‐up after SDR in children with CP. The authors independently screened publications to determine whether they met inclusion criteria; thereafter all authors extracted data on patient characteristics, the proportion of the original cohort being followed‐up, and the reported outcomes. Results Of the 199 studies identified, 16 were included in this evaluation: 14 were case series and two studies reported a retrospectively assigned comparison group. Evidence concerning function was limited by study design differences, clinical variability, loss to follow‐up, and heterogeneity across trials. Interpretation At 10 years or more follow‐up, available studies generate low‐level evidence with considerable bias. No functional improvement of SDR over routine therapy is documented. Furthermore, the long‐term effects of SDR with respect to spasticity reduction is unclear, with many studies reporting a high amount of add‐on spasticity treatment. More long‐term follow‐up using robust scientific protocols is required before it can be decided whether the use of SDR as routine therapy for children with CP is to be recommended or not. What this paper adds Ten years after selective dorsal rhizotomy, available studies supply inconclusive evidence on functional outcomes. The long‐term effect on spasticity is uncertain, studies reported a substantial need for add‐on treatment. Short‐ and long‐term complications seem frequent but are not reported in a consistent manner.

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“…Seven out of the 16 studies evaluated the effect on spasticity specifically, and all reported sustained long‐term reduction or even normal muscle tone …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Tedroff

Hägglund

Miller

2019

Develop Med Child Neuro

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“…Previous prospective studies in a single, small sample of people who have undergone SDR have demonstrated reductions in spasticity, pain intensity, and pain interference that are maintained even years after SDR . Although previous studies have demonstrated short‐ and long‐term benefits of SDR in terms of reduced spasticity, prospective studies have differed over the benefit in functional outcomes . Furthermore, other than one study of 18 people that showed that SDR was related to relatively low pain and pain interference, we lack understanding of how SDR affects symptom experience as individuals age.…”

mentioning

confidence: 97%

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

Daunter

Kratz

Hurvitz

2017

Develop Med Child Neuro

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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.

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“…4,5 Children with CP often have other associated impairments of sensation, perception, communication, cognition and behaviour. 4,5 Children with CP often have other associated impairments of sensation, perception, communication, cognition and behaviour.…”

Section: Spinal Dorsal Rhizotomy Plus Concurrent Left and Right Gastrmentioning

confidence: 99%

Spinal dorsal rhizotomy plus concurrent left and right gastrocnemii releases in a 7‐year‐old child with haemophilia A and spastic cerebral palsy

et al. 2019

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Long-term outcome after selective dorsal rhizotomy in children with spastic cerebral palsy

Abstract: SDR yields durable reduction in spasticity after 10 years. Early improvements in motor function are present, but at long-term follow-up, these improvements were attenuated in GMFCS II and III and were not sustained in GMFCS IV and V.

Cited by 62 publications

References 22 publications

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

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

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

Spinal dorsal rhizotomy plus concurrent left and right gastrocnemii releases in a 7‐year‐old child with haemophilia A and spastic cerebral palsy

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