A prospective cohort study investigating gross motor function, pain, and health‐related quality of life 17 years after selective dorsal rhizotomy in cerebral palsy

• Published in: Developmental medicine and child neurology 2015-05, Vol.57 (5), p.484-490
• Main Authors: Tedroff, Kristina, Löwing, Kristina, Åström, Eva
• Format: Article
• Language: English
• Subjects: Adult; Cerebral Palsy - surgery; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Medicin och hälsovetenskap; Motor Activity - physiology; Muscle Spasticity - surgery; Muscle Tonus - physiology; Pain - surgery; Quality of Life; Range of Motion, Articular - physiology; Rhizotomy - methods; Severity of Illness Index; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0012-1622; 1469-8749; 1469-8749
• DOI: 10.1111/dmcn.12665

Aim The aim of this study is to evaluate the long‐term effects of selective dorsal rhizotomy (SDR), 15 to 20 years after surgery in patients with cerebral palsy. Method Eighteen children (four females, 14 males; mean age at SDR 4y 7mo, SD 1y 7mo) with bilateral spastic cerebral palsy (CP), were prospectively assessed after SDR. This study focuses on the outcome 15 to 20 years after the procedure. The assessments include the Modified Ashworth Scale for spasticity, the Gross Motor Function Measure (GMFM‐88), the Wilson Mobility Scale, The Health‐Related Quality of Life Health Survey, SF‐36v2, and the Brief Pain Inventory. Results The effect of normalized muscle tone in lower extremities after SDR was sustained after a median of 17 years. The best gross motor function capacity, according to the GMFM score, was seen at the 3‐year follow‐up, thereafter a gradual decline followed. Half of the individuals reported low intensity pain and interference. Compared to a norm sample the physical health component of SF‐36v2 was slightly lower and the mental health component slightly higher. Interpretation The spasticity‐reducing effect of SDR does not improve long‐term functioning, nor prevent contractures, but it can possibly reduce the pain often experienced by individuals with CP. What this paper adds Seventeen years after selective dorsal rhizotomy (SDR), the muscle tone in lower extremities was still normalized in children with spastic diplegic CP. Reduced spasticity possibly affected pain experience positively. Gross motor function, when assessed by GMFM‐88 and by a mobility scale, deteriorated further between 10 years and 17 years after SDR. SDR did not prevent the development of contractures. This article is commented on by Vermeulen and Becher on pages 408–409 of this issue.