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Effectiveness of Selective Dorsal Rhizotomy In Adolescents/Young Adults with Cerebral Palsy

Saturday, October 20, 2012: 10:57 AM
Melrose (Hilton Riverside)
Daniel Tobert, BS1, Hiroko Matsumoto, MA1, Joshua E. Hyman, MD, FAAP1, Benjamin Roye, MD, MPH1, Richard C. E. Anderson, MD2 and David P. Roye Jr., MD1, (1)Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, (2)Division of Pediatric Neurological Surgery, Department of Neurological Surgery, Columbia University College of Physicians and Surgeons, Children's Hospital of New York-Presbyterian, New York, NY

Purpose

Selective dorsal rhizotomy (SDR) is a procedure performed to reduce tone and pain in patients with spastic cerebral palsy (CP). Traditional indications for this procedure include borderline ambulators between the ages of 3 and 8 without rigidity, dystonia, athetosis and ataxia. Recent literature studying outcomes of SDR indicate a decline in function when SDR is performed in the ambulating adolescent population. However, there is no data on pain, tone, range of motion (ROM) or quality of life for patients of all levels of involvement. The purpose of this study is to assess whether SDR is an effective way to reduce pain and tone and increase range of motion and patient-reported outcomes (PRO) in adolescents and young adults with CP.

Methods

14 patients with CP who underwent SDR (spastic quadriplegia n=6, spastic diplegia n=8, age range at surgery 13-27, male n=9, female n=5, GMFCS Class I n=1, Class II n=3, Class III n=3, Class IV n=4, Class V n=3) were identified through a retrospective chart review. Patients were assessed preoperatively and postoperatively for pain, tone, range of motion and PRO as part of standard of care. All patients had at least one year of follow-up (mean 21.4 ± 9.4 mos). Pain was assessed through patient report and documented in the electronic medical record. Tone was recorded using the Modified Ashworth Scale, ROM was measured with a goniometer, and PRO assessed by the Rehab Institute of Chicago Care and Comfort Caregiver Questionnaire.

Results

Statistically significant (p<0.05) reductions of tone occurred in the hip extensors and adductors, knee flexors and extensors and plantar flexors in comparison to preoperative values. Nine patients (64.3%) complained of pain before surgery and 2 (14.2%) complained of pain postoperatively. There was not a significant change in ROM. Questions involving pain in the RIC-CCCQ trended towards significance, but inadequate response rates prevented meaningful analyses.

Conclusion

There was a statistically significant reduction in lower extremity tone after SDR across all GMFCS levels. In addition, 77.7% of patients complaining of pain preoperatively no longer had pain at follow up. Despite this procedure being performed for mobility purposes in the young child population, this study suggests pain and tone reduction should be an additional consideration for performing SDR in the adolescent/young adult population and lays the groundwork for a prospective trial in the future.