Long Term Benefits of Selective Dorsal Rhizotomy

The Journal of Neurosurgery published research on the long term benefits of selective dorsal rhizotomy (SDR) in children with cerebral palsy.  The participants in the study included 102 children with spastic CP who underwent SDR between the ages of 3 and 10 years and were evaluated by a multidisciplinary team before surgery and periodically afterward. After evaluating the data the following results were seen:

• statistically significant improvements in lower-limb muscle tone, gross motor function, and the ability to perform activities of daily living in the majority of patients.
• the improvements lasted throughout adolescence and into early adulthood 
• children performed better who had better preoperative gross motor function (GMFCS Groups I through III), spasticity involved only two limbs, rather than three or four and spasticity involved the adductor muscles of the hip only moderately (Ashworth score lower than 3)
• following SDR children were less likely to need adjunct orthopedic surgeries or Botox injections to control spasticity

Reference: Dudley RWR, Parolin M, Gagnon B, Saluja R, Yap R, Montpetit K, Ruck J, Poulin C, Cantin MA, Benaroch, TE, Farmer JP. Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. Clinical article. Journal of Neurosurgery: Pediatrics, published online, ahead of print, May 28, 2013; DOI: 10.3171/2013.4.PEDS12539

Long Term Functional Outcomes After SDR

Long term follow up data was analyzed pre-operatively, 1 year, 5 years, 10 years and 15 years from 102 patients with spastic cerebral palsy who had a selective dorsal rhizotomy (SDR).  The results indicated the following:

• statistically significant improvements seen in spasticity, Gross Motor Function Measure (GMFM), activities of daily living up to 10 and 15 years after SDR (ie, though adolescence and into early adulthood).
• when severity of the Gross Motor Function Classification System (GMFCS) was taken into account the researchers found longlasting improvements through adolescence, which were not seen in the previously reported natural history curves for patients who did not have SDR
• patients had half as many orthopedic procedures as reported in the literature for patients without SDR

Reference: Dudley RW, Parolin M, Gagnon B, Saluja RS, Yap R, Monpetit K, Ruck J, Poulin C, Cantin MA, Benaroch T, Farmer JP. Beneficial Functional Outcomes of Selective Dorsal Rhizotomy (SDR) Are Long Lasting and Alter the Natural History of Motor Development in Spastic Cerebral Palsy. Neurosurgery. 2012 Aug;71(2):E564-5.