No Increased Risk for Scoliosis After Early Selective Dorsal Rhizotomy - A Longitudinal Population-Based Controlled Registry Study from four to 25 years of Age

Abstract

Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery increases the risk for later spine problems. Using CP-registry data from a geographically defined population with the same health care and habilitation services, the objectives were to compare reported scoliosis and spinal pain up to adult age in all SDR-operated with all non-SDR-operated individuals with same medical history, functional abilities, and level of spasticity at four years of age. Method In the total population with CP spastic diplegia in Skåne and Blekinge, born 1990-2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at four years of age and were included; 36 persons had undergone SDR at a median age of 4.0 years (range 2.5 – 6.6 years), and 113 individuals constituting the control group, had not. Data on scoliosis and spinal pain at 10, 15, 20 and 25 years of age were analyzed using Kaplan-Meier survival curves and Fisher’s exact test. Gross motor function classification (GMFCS) levels at four years of age (or pre-operatively) were used for stratification.Result Presence of scoliosis at 15, 20, and 25 years of age was the same in the SDR group as in the control group (p=0.734, 0.735 and 1.0). In severe functional disability (GMFCS IV), the SDR group had later onset and lower occurrence of scoliosis (p=0.004) than the control group. Frequency of reported spinal pain did not differ between the groups. Conclusion Neither scoliosis, nor spinal pain was more frequent after SDR than expected by natural history. On the contrary, in severe CP (GMFCS level IV), scoliosis was less frequently reported and had a later onset in the SDR group than in the same GMFCS-level control group.