The effect of GMFCS level, age, sex, and dystonia on multi-dimensional outcomes after selective dorsal rhizotomy: prospective observational study

Abstract

Purpose: Investigate the effect of age category (1-9 years vs 10-18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in eight function test parameters 24 months after selective dorsal rhizotomy (SDR).

Methods: Prospective, single-center study of all children aged 3-18 years with bilateral cerebral palsy with spasticity who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2019. A linear mixed effects model was used to assess longitudinal changes.

Results: From 2012 to 2019, 42 children had follow-up available at 24 months. Mean GMFM-66 scores increased after SDR (mean difference 5.1 units: 95% CI 3.05-7.13, p < 0.001). Statistically significant improvements were observed in CPQoL, PEDI Self-care and Mobility, 6MWT, Gillette, and MAS scores. There was no significant difference in the improvements seen for age category, sex, GMFCS level, and presence of dystonia for most of the parameters tested (5/8, 6/8, 5/8, and 6/8 respectively).

Conclusion: SDR may improve gross and fine motor function, mobility and self-care, quality of life, and overall outcome based on extensive scoring parameter testing at 24 months. Atypical patient populations may benefit from SDR if appropriately selected. Multi-center, prospective registries investigating the effect of SDR are required.

Keywords: Cerebral palsy; GMFCS; GMFM; SDR.

Fig. 1

Spaghetti plot of a GMFM-66, c CPQoL (primary caregiver), e Modified Ashworth Scale (MAS), and g PEDI Self-care score over time, demonstrating an improvement after SDR. b, d, f, and h show the smoothed conditional means with standard error over time (y ≠ 0)

Fig. 1

Spaghetti plot of a GMFM-66, c CPQoL (primary caregiver), e Modified Ashworth Scale (MAS), and g PEDI Self-care score over time, demonstrating an improvement after SDR. b, d, f, and h show the smoothed conditional means with standard error over time (y ≠ 0)

Fig. 2

Spaghetti plot of a PEDI Mobility, c TUG, e 6MWT, and g Gillette FAQ scores over time, demonstrating an improvement after SDR. In 6MWT and Gillette, there is an initial decrease in scores, followed by an increase. b, d, f, and h show the smoothed conditional means with standard error over time (y ≠ 0)

Fig. 2

Spaghetti plot of a PEDI Mobility, c TUG, e 6MWT, and g Gillette FAQ scores over time, demonstrating an improvement after SDR. In 6MWT and Gillette, there is an initial decrease in scores, followed by an increase. b, d, f, and h show the smoothed conditional means with standard error over time (y ≠ 0)