Long-term functional outcomes post-selective dorsal rhizotomy: a ten-year follow-up

Long-term functional outcomes post-selective dorsal rhizotomy: a ten-year follow-up
J RUCK MSC A6, K MONTPETIT MSC (A) 5, M PAROLIN MD1, R SALUJA 3, J FARMER1, C POULIN2,
T BENAROCH 4, 7, M CANTIN 7
1Pediatric Neurosurgery, McGill University Health Centre, Montreal Children’s Hospital, Montreal, QC;
2Pediatric Neurology, McGill University Health Centre, Montreal Children’s Hospital, Montreal, QC
3Neurosurgery, McGill University Health Centre, Montreal, QC;
4Pediatric Orthopaedic Surgery, McGill University Health Centre, Montreal, QC;
5Occupational Therapy, Shriners Hospitals for Children-Canada, Montreal, QC;
6Physiotherapy, Shriners Hospitals for Children-Canada, Montreal, QC;
7Pediatric Orthopaedics, Shriners Hospitals for Children – Canada, Montreal, QC, Canada

Background/Objectives: Spasticity is an important problem faced by children with cerebral palsy. Although several treatment options exist for these children, to date, few have been shown to be effective in improving long term functional outcomes. Our group has previously shown that selective dorsal rhizotomy (SDR) improved functional outcomes up to 5 years post-operatively in children with locomotor potential. The current study aims to determine if the functional improvements are maintained at 10 years follow-up.
Design: Cohort prospective stud.
Participants and Setting: One hundred and eighty seven children with spastic type of cerebral palsy followed in a multidisciplinary spasticity clinic at a paediatric orthopaedic hospital who underwent SDR.
Materials/Methods: The children underwent a standardized assessment protocol pre-operatively and at 6 months, 1, 3, 5, 10 and 15 years post-operatively. Of the 75 children operated on 10 or more years ago,42 children completed a full 10 years follow-up evaluation including quantitative measures of lower extremity spasticity, range of motion and isolation of movement. Gross motor function was measured with the gross motor functional measure (GMFM) in 42 children. Functional performance was measured with the paediatric evaluation of disability inventory (PEDI) in 63 children. Time points of early (6 months to 2 years), intermediate (3-5) and long-term (10-15 years) follow-up were used to analyze the differences over time.
Results: Statistical analysis of the data showed improvements in lower extremity spasticity and isolation of movement compared to pre-operative baseline. The total GMFM score was 66.4, 74.7, 82.8, and 81.1 at preoperative, early, intermediate and long-term follow-up time points respectively. The improvement in the GMFM score was more evident in the standing and walking dimensions and particularly in independent ambulators. Children who underwent SDR made significant improvements in both the self-care and mobility domains of the PEDI. Mean scores for the self-care domain at pre-operative, intermediate and long term were 58.9, 81.7 and 88.7 respectively. A similar trend was present for the mobility domain with mean scores at these time points of 56.2, 75.3 and 80.3 respectively. Furthermore, children who were independent ambulators with or without aid made the most significant gains, although children who used reciprocal crawling as a means of mobility also improved.
Conclusions/Significance: This study demonstrated that SDR for children with spastic cerebral palsy led to significant improvements in motor function, mobility and self-care 10 years post-surgery. Although the gains in GMFM were maintained at 10 years post-operatively no significant improvements were noted from 5 to 10 years. However, the improvements in the self-care and mobility domain mean scores of the PEDI continued to improve from 5 to 10 years post-SDR.

 
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