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Selective Dorsal Rhizotomy for Cerebral Palsy: Significant Gains in Mobility and Reduction in Spasticity Treatments

Selective Dorsal Rhizotomy for Cerebral Palsy: Significant Gains in Mobility and Reduction in Spasticity Treatments 928 1024 Erin Gregory

Recent research shows that selective dorsal rhizotomy (SDR) significantly boosts motor function in children with cerebral palsy (CP), particularly those who are ambulatory. The study highlights motor improvements and a reduced need for spasticity treatments, emphasizing SDR’s potential to enhance outcomes and quality of life for children with CP.

Key Findings: Improvements in Motor Function and Reduced Spasticity Treatments

A core outcome of the study was the noticeable improvement in motor function among ambulatory children, as demonstrated by higher GMFM-66 scores in follow-up assessments. While nonambulatory children experienced less improvement in motor function, SDR still provided benefits across both groups by reducing the need for spasticity treatments such as baclofen and botulinum toxin injections. This reduction in treatment needs helped lessen the burden of these therapies, which often come with side effects and high costs.

Assessing for Intraoperative Nerve Responses

The study had two main objectives: evaluating postoperative functional outcomes and analyzing intraoperative nerve stimulation responses. The study assessed 35 children for motor outcomes and 112 children for intraoperative nerve responses. All participants had spastic CP, with the majority diagnosed with diplegia, which primarily affects both legs. The average age of the patients was approximately 7 years, and both ambulatory and nonambulatory children were included.

Researchers assessed gross motor function and muscle tone and tracked the need for spasticity treatments postoperatively. The study captured functional improvements as well as changes in treatment needs over a two-year period following SDR.

“Our ongoing evaluation of selective dorsal rhizotomy outcomes, especially over a two-year period, is essential in understanding not only motor function improvements but also the broader benefits, including those to the upper extremities,” says Jeffrey Leonard, MD, chief of Neurosurgery and the Robert F. & Edgar T. Wolfe Foundation Endowed Chair in Neurosurgery at Nationwide Children’s. “This comprehensive approach helps us refine treatment protocols for children with cerebral palsy.”

Intraoperative Nerve Stimulation: Understanding Neurophysiological Changes

The study also provided insights into neurophysiological changes during SDR, with analysis of over 5,500 nerve rootlets revealing lower stimulation thresholds and higher response grades, especially on the left side and in the lower (lumbosacral) spinal regions. These findings shed light on how CP affects nerve signaling, offering data that may guide future surgical decisions.

“The goal with intraoperative nerve stimulation is to further define how responses shift in children with cerebral palsy,” Dr. Leonard says. “As we continue to refine this, I believe it will improve our ability to predict outcomes and select candidates for SDR with greater accuracy.”

Overall, these findings show that Selective Dorsal Rhizotomy provides meaningful improvements in mobility and reduces the need for spasticity treatments in children with CP. As research expands, SDR holds promise for further refining treatment protocols and enhancing the of life for those affected by cerebral palsy.

 

Reference:

Makoshi Z, Islam M, McKinney J, Leonard J. Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy. Acta Neurochir (Wien). 2024 Jul 30;166(1):308. doi: 10.1007/s00701-024-06187-8. PMID: 39078485; PMCID: PMC11289343.

Image credit: Nationwide Children’s

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