No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain – a longitudinal population-based register 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 causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at 4 years of age. Variables associated with scoliosis at 20 years of age were explored. 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 4 years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5–6.6 years), and 113 had not. Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at 4 years of age were used for stratification. Result Frequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p = 0.004). Frequency of spinal pain did not differ between the groups (p- levels > 0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age. Conclusion Frequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.

Multidimensional Outcomes of Selective Dorsal Rhizotomy for Children With Spastic Cerebral Palsy: Single-Level Laminectomy vs Multiple-Level Laminotomy Techniques

“…33,34 The exact risk of postoperative scoliosis remained unclear because the natural scoliosis rate could range from 15% to 80% among patients with cerebral palsy. 35 Josenby and Westbom 36 suggested no evidence for a scoliosis frequency increase after SDR. In our study, the MLL group was not evidenced to have a higher rate of scoliosis than the SLL group, given that the patients in the MLL group were observed for an even longer duration.…”

Secondary Musculoskeletal Disorders in Spastic Forms of Cerebral Palsy: A Literature Review

“…Нарушенный фронтальный баланс туловища вызывает неравномерное распределение веса на седалищные бугры во время сидения, что впоследствии приводит к появлению стойкого болевого синдрома и даже пролежней в области наибольшего давления на мягкие ткани. Также сколиоз у детей с ДЦП вызывает боли на вогнутой стороне деформации в области поясницы и ребер, которые у некоторых пациентов упираются в подвздошную кость [14,16,18].…”