Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials.
This study is a comparative analysis and meta-analysis of three randomized clinical trials. Children with spastic diplegia received either 'selective' dorsal rhizotomy (SDR) plus physiotherapy (SDR+PT) or PT without SDR (PT-only). Common outcome measures were used for spasticity (Ashworth scale) and function (Gross Motor Function Measure [GMFM]). Baseline and 9- to 12-month outcome data were pooled (n=90). At baseline, 82 children were under 8 years old and 65 had Gross Motor Function Classification System level II or III disability. Pooled Ashworth data analysis confirmed a reduction of spasticity with SDR+PT (mean change score difference -1.2; Wilcoxonp<0.001). Pooled GMFM data revealed greater functional improvement with SDR+PT (difference in change score +4.0, p=0.008). Multivariate analysis in the SDR+PT group revealed a direct relationship between percentage of dorsal root tissue transected and functional improvement. SDR+PT is efficacious in reducing spasticity in children with spastic diplegia and has a small positive effect on gross motor function.
McLaughlin
John
J
Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA. jfmcl@u.washington.edu
Bjornson
Kristie
K
Temkin
Nancy
N
Steinbok
Paul
P
Wright
Virginia
V
Reiner
Ann
A
Roberts
Theodore
T
Drake
James
J
O'Donnell
Maureen
M
Rosenbaum
Peter
P
Barber
Jason
J
Ferrel
Anne
A
D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D005260:Female; D005727:Ganglia, Spinal / Q000601:surgery*; D006801:Humans; D008297:Male; D009048:Motor Skills; D016032:Randomized Controlled Trials as Topic; D019051:Rhizotomy; D016896:Treatment Outcome