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

Abstract

Selective dorsal rhizotomy (SDR) and non-SDR groups had significant improvement in gait pathology over time. The non-SDR group had significantly better gait compared with the SDR group at follow-up. The groups had similar levels of energy cost, pain, and quality of life. Non-SDR participants underwent significantly more orthopaedic surgery and antispasticity injections than SDR participants. Use of a clinically similar control group highlights that different treatment courses may result in similar outcomes into young adulthood.

Evaluating treatment options for spasticity

“…If it is gait quality, the non‐SDR group did better; while outcome in terms of level of spasticity and number of orthopaedic interventions and anti‐spasticity injections was better in the SDR group. In this study, there was no difference between the groups with respect to pain, functional level and quality of life, and energy expenditure …”

“…All the patients had baseline gait analysis (including physical examination, metabolic energy cost, and barefoot kinematics) and all completed six survey‐based outcome measures. Notably, only 13 out of 24 (54%) of the SDR group and 8 out of 11 (72%) of the non‐SDR group underwent follow‐up gait analysis, which is regrettable as gait quality (as reflected in Gait Deviation Index) was one of the important long‐term outcomes of this study …”

“…A persistent criticism however has been the lack of sufficient evidence of efficacy from RCTs. The study by Munger et al presents a novel approach to providing a higher level of evidence to guide practitioners in selecting the best treatment option for these children …”

“…Munger et al retrospectively matched patients who had not undergone SDR to a very well‐characterized cohort of those who underwent SDR 10 to 17 years earlier. The authors utilized a ‘propensity model’ which enabled them to identify 96 eligible patients, of whom 35 ultimately participated in the study and of these, 24 had undergone SDR and 11 had not …”

“…Given the retrospective nature of the study, the groups were not equally matched, with the non‐SDR group being quite heterogenous, having more orthopaedic interventions and three patients also having received intrathecal baclofen. Furthermore, the reasons why these patients had not undergone SDR were unknown and might explain the differences in the groups, as acknowledged by the authors …”