Selective dorsal rhizotomy: efficacy and safety in an investigator‐masked randomized clinical trial

Abstract

The objective of this single‐center investigator‐masked randomized clinical trial was to investigate the efficacy and safety of selective dorsal rhizotomy (SDR) in children with spastic diplegia. Forty‐three children with spastic diplegia were randomly assigned on an intention‐to‐treat basis to receive SDR plus physical therapy (PT), or PT alone. Thirty‐eight children completed follow‐up through 24 months. Twenty‐one children received SDR (SDR+PT group) and 17 received PT (PT Only group). SDR was guided with electrophysiological monitoring and performed by one experienced neurosurgeon. All subjects received equivalent PT. Spasticity was quantified with an electromechanical torque measurement device (spasticity measurement system [SMS]). The Gross Motor Function Measure (GMFM) was used to document changes in functional mobility. Primary outcome measures were collected at baseline, 6, 12, and 24 months by evaluators masked to treatment. At 24 months, the SDR+PT group exceeded the PT Only group in mean reduction of spasticity by SMS measurement (‐8.2 versus +5.1 newton meters/radian, P=0.02). The SDR+PT group and the PT Only group demonstrated similar improvements in independent mobility on the GMFM (7.0 versus 7.2 total percent score, P=0.94). Outcomes on secondary variables were consistent with primary outcomes. There were no serious adverse events. We conclude that SDR is safe and reduces spasticity‐in children with spastic diplegia. SDR plus PT and equivalent PT without SDR result in equal improvements in independent mobility at 24 months. SDR may not be an efficacious treatment for children with mild spastic diplegia.

Single-level selective dorsal rhizotomy for spastic cerebral palsy

“…There was also a direct linear correlation between the number of dorsal roots divided and the gains in GMFM. This was an important finding as it explained the poorer outcome in the Seattle group (24), which divided a mean of 25% of the dorsal roots rather than the currently accepted technique of dividing 50-75%. These improvements in GMFM have not always been shown to translate to gains in social participation (23).…”

Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria

“…3,9,25 This strategy resulted in a significant reduction in adverse effects without loss of efficacy in spasticity relief, as verified in multiple randomized studies. 8,20,21,33 Nonselective dorsal rhizotomy, in which some dorsal nerve rootlets (usually about 50%) are divided without neurophysiological investigation, appears to produce similar results. 27 Patient selection is important in maximizing chances for a satisfactory result from SDR.…”

“…Patients with dystonia or athetoid movement disorders do not benefit from SDR. Most SDR studies have focused on children with CP; 8,20,21,33 clinical conditions such as spastic hemiplegia, and diagnoses such as hypoxic encephalopathy as is noted in cases of near drowning, are generally listed as contraindications to SDR. 24 Assessing the suitability of patients for SDR who fall outside traditional parameters is restricted by limited data.…”

Effects of Yoga on Sleep Quality, Depression in Children with Cerebral Palsy

“…Oral medication, intramuscular botulinum toxin injection, multi-level orthopedical surgery, intratecal baclofen application, selective dorsal rhizotomy, physiotherapy applications, orthesis approaches and many alternative treatment methods are among these [11].…”