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Selective Dorsal Root Rhizotomy for Spastic Cerebral Palsy: A Longitudinal Case-Control Analysis of Functional Outcome.

Authors
  • Iorio-Morin, Christian1, 2
  • Yap, Rita3
  • Dudley, Roy W R1
  • Poulin, Chantal4
  • Cantin, Marie-Andrée5
  • Benaroch, Thierry E6
  • Farmer, Jean-Pierre1
  • 1 Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Canada. , (Canada)
  • 2 Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Canada. , (Canada)
  • 3 Physical Therapy, Shriners Hospital for Children, Montreal, Canada. , (Canada)
  • 4 Division of Neurology, Montreal Children's Hospital, Montreal, Canada. , (Canada)
  • 5 Division of Orthopedic Surgery, Department of Pediatric Surgery, CHU Sainte-Justine and Shriners Hospital for Children, Université de Montréal, Montreal, Canada. , (Canada)
  • 6 Division of Orthopedic Surgery, Department of Pediatric Surgery, Montreal Children's Hospital and Shriners Hospital for Children, McGill University, Montreal, Canada. , (Canada)
Type
Published Article
Journal
Neurosurgery
Publication Date
Aug 01, 2020
Volume
87
Issue
2
Pages
186–192
Identifiers
DOI: 10.1093/neuros/nyz422
PMID: 31620799
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The benefit of selective dorsal rhizotomies (SDR) on motor function relative to the cerebral palsy (CP) natural history remains unknown. To determine the functional benefit of SDR over the longitudinal CP natural history. Retrospective, single-center, case-control study of patients post-SDR after 1990. Inclusion criteria were the following: diagnosis of spastic CP, at least 1 preoperative and 1 postoperative Gross Motor Function Measure (GMFM-88), at least 1 yr of postoperative follow-up. GMFM-88 assessments were performed at 1, 2, 3, 5, 10, and 15 yr postoperatively and converted to GMFM-66. Cases were stratified by preoperative Gross Motor Function Classification System (GMFCS) and matched against their expected natural history using published reference centiles. After age 12, our cohort and matched controls were also fitted to published nonlinear mixed models of GMFM-66 evolution over time. Analysis included 190 patients. Median follow-up, 5.3 yr (range: 1-16.9), median age at surgery, 4.6 yr, and 81.6% of patients grouped as GMFCS II or III pre-op. SDR patients performed statistically significantly better than their expected natural history (P < .0005). At 21 yr old, a modeled benefit of 8.435 was observed for GMFCS I (P = .0051), 0.05 for GMFCS II (P = .9647), 6.31 for GMFCS III (P < .0001), and 1.191 for GMFCS IV patients (P = .0207). These results support the use of SDR in carefully selected spastic CP children. Copyright © 2019 by the Congress of Neurological Surgeons.

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