Outcome of Therapies for Spasticity Treated with Selective Dorsal Rhizotomy in Children

Outcome after Surgery

• Stabile improvement: 25- to 35-year follow-up data from the Cape Town group shows sustained long-term improvement in muscle tone and function in patients after SDR. Improved mental health and quality-of-life scores are also reported in patients after SDR, when compared with typically developing adults (45).
• Statistically significant improvement in function: Functional improvements have been found to be statistically significant at one year after SDR in two out of three randomized clinical trials (6, 8,18). Locomotor patients (GMFSC Groups 1 and 2) with independent ambulation, ambulation with assistive devices  or preoperative reciprocal crawling (“bunny hopping”) have all shown statistical improvement in the GMFM scores, PDMS  scores and PEDI scores at 5 years, that have persisted at 10- to 15-year follow-up (18). Because the average age at surgery is 5 years, this means that at the 10- to 15-year follow-up, these patients are beyond their adolescent growth spurts.
• Persisting but slowing improvement in GMFM scores after 5 years: Improvement of GMFM scores  and particularly those of dimension D and E were noted to continue beyond 5 years albeit at a slightly slower pace (18). This improvement was particularly notable in patients who were functioning at a GMFCS grade 1, 2, and 3 level prior to their adolescent growth spurts.

GMFM score changes over time. Line plots comparing GMFM total scores (left), dimension D (center), and dimension E (right) in patients in the study according to the preoperative level of functioning. Patients were subdivided into five groups according to their locomotive abilities. Dimensions D and E primarily related to lower extremity motor function and are the primary outcome measures of the GMFM (18).

• Fine motor function improvement: Fine motor skill improvements have also been noted to be durable beyond the 10- to 15-year follow-up (11).
• Increased bladder capacity: We demonstrated earlier via urodynamic studies that lower bladder pressures and increased bladder volumes were seen in patients after SDR, suggesting a somewhat “protective” effect of SDR on the bladder in the long term (13).
• Protective against severe scoliosis: Prolonged follow-up for spine curvature in children undergoig SDR revealed that, although up to 40–45% of patients do show a ≥10% scoliosis curve, until recently not a single patient needed bracing or orthopedic procedure (9). In general, SDR seems to have a protective effect against progression of the degree of scoliosis to  beyond 20 degrees in those showing >10 degrees curves preoperatively with approximately 55% of patients showing no evidence of scoliosis (<10-degree curves after their surgery) (9).
  What to tell families: It is safe to counsel families that it does not seem as though SDR increases the risk of severe spinal deformities above that risk that is inherent with CP already. It actually may be protective, as stated above.