Long-term outcomes five years after selective dorsal rhizotomy

Nordmark, Eva; Josenby, Annika Lundkvist; Lagergren, J; Andersson, Gustav; Strömblad, Lars-Göran; Westbom, Lena

doi:10.1186/1471-2431-8-54

Cited by 108 publications

(125 citation statements)

References 49 publications

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“…Peacock's original cohort has now been followed up for over 20 years and it is evident that the benefits they gained as children are still present (32). Nordmark et al and Josenby et al found that patients also had improvements in their Paediatric Evaluation of Disability Inventory (PEDI) scores, notably in the functional skills and mobility domains (27,31). Dudley et al found that these gains persisted to 15 years post-SDR (29).…”

Section: Outcome Of Sdrmentioning

confidence: 95%

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Graham¹,

Aquilina²,

Cawker³

et al. 2016

J. Spine Surg.

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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.

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Section: Outcome Of Sdrmentioning

confidence: 95%

Single-level selective dorsal rhizotomy for spastic cerebral palsy

Graham¹,

Aquilina²,

Cawker³

et al. 2016

J. Spine Surg.

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show abstract

“…7 Two of 3 randomized control trials and a metaanalysis of those trials have revealed the functional benefits of SDR, at least up to 2 years after surgery. [12][13][14]16,20,23 However, no study has reported long-term data on large numbers of patients using standardized functional assessment tools; thus it remains unresolved whether SDR impacts the natural history of gross motor development in CP. Using validated assessment tools, we assessed whether functional benefits of SDR are durable through adolescence and into early adulthood.…”

mentioning

confidence: 99%

Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy

Dudley

Parolin

Gagnon

et al. 2013

PED

116

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Object Large-scale natural history studies of gross motor development have shown that children with spastic cerebral palsy (CP) plateau during childhood and actually decline through adolescence. Selective dorsal rhizotomy (SDR) is a well-recognized treatment for spastic CP, but little is known about long-term outcomes of this treatment. The purpose of this study was to assess the durability of functional outcomes in a large number of patients through adolescence and into early adulthood using standardized assessment tools. Methods The authors analyzed long-term follow-up data in children who had been evaluated by a multidisciplinary team preoperatively and at 1, 5, 10, and 15 years after SDR. These evaluations included quantitative, standardized assessments of lower-limb tone (Ashworth Scale), Gross Motor Function Measure (GMFM), and performance of activities of daily living (ADLs) by the Pediatric Evaluation of Disability Inventory in children who had been stratified by motor severity using the Gross Motor Function Classification System (GMFCS). In addition, group-based trajectory modeling (GBTM) was used to identify any heterogeneity of response to SDR among these treated children, and to find which pretreatment variables might be associated with this heterogeneity. Finally, a chart review of adjunct orthopedic procedures required by these children following SDR was performed. Results Of 102 patients who underwent preoperative evaluations, 97, 62, 57, and 14 patients completed postoperative assessments at 1, 5, 10, and 15 years, respectively. After SDR, through adolescence and into early adulthood, statistically significant durable improvements in lower-limb muscle tone, gross motor function, and performance of ADLs were found. When stratified by the GMFCS, long-lasting improvements for GMFCS Groups I, II, and III were found. The GBTM revealed 4 groups of patients who responded differently to SDR. This group assignment was associated with distribution of spasticity (diplegia was associated with better outcomes than triplegia or quadriplegia) and degree of hip adductor spasticity (Ashworth score < 3 was associated with better outcomes than a score of 3), but not with age, sex, degree of ankle plantar flexion spasticity, or degree of hamstring spasticity. In a sample of 88 patients who had complete records of orthopedic procedures and botulinum toxin (Botox) injections, 52 (59.1%) underwent SDR alone, 11 (12.5%) received only Botox injections in addition to SDR, while 25 patients (28.4%) needed further lower-extremity orthopedic surgery after SDR. Conclusions In the majority of patients, the benefits of SDR are durable through adolescence and into early adulthood. These benefits include improved muscle tone, gross motor function, and performance of ADLs, as well as a decreased need for adjunct orthopedic procedures or Botox injections. The children most likely to display these long-term benefits are those in GMFCS Groups I, II, and III, with spastic diplegia, less hip adductor spasticity, and preoperative GMFM scores greater than 60.

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“…Nordmark et al (2008) assessed spasticity and function in children with spastic diplegia 5 years after undergoing SDR [5]. They report that children (ranging from GMFCS I to V) undergoing SDR exhibited persistent improvement in spasticity, gross motor function, functional skills, ability to self care and mobilisation.…”

Section: Discussionmentioning

confidence: 97%