title: Predictors for the benefit of selective dorsal rhizotomy.
abstract: Selective dorsal rhizotomy (SDR) is a spasticity reducing treatment option for children with spastic cerebral palsy. Selection criteria for this procedure are inconclusive to date. Clinical relevance of the achieved functional improvements and side effects like the negative impact on muscle strength are discussed controversially. In this prospective cohort study one and two year results of 54 children with a mean age of 6.9 (±2.9) years at the time of SDR are analyzed with regard to gross motor function and factors affecting the functional benefit. Only ambulatory children who were able to perform a gross motor function measure test (GMFM-88) were included in this study. Additionally, the modified Ashworth scale (MAS), a manual muscle strength test (MFT), and the body mass index (BMI) were evaluated as possible outcome predictors. MAS of hip adductors and hamstrings decreased significantly (p<0.001) and stayed reduced after two years, while GMFM improved significantly from 79% to 84% 12 months after SDR (p<0.001) and another 2% between 12 and 24 months (p=0.002). Muscle strength did improve significantly concerning knee extension (p=0.008) and ankle dorsiflexion (p=0.006). The improvement of function correlated moderately with age at surgery and preoperative GMFM and weakly with the standard deviation score of the BMI, the dorsiflexor and plantarflexor strength preoperatively as well as with the reduction of spasticity of the hamstrings and the preoperative spasticity of the adductors and hamstrings. Correctly indicated SDR reduces spasticity and increases motor skills sustainably in children with spastic cerebral palsy corresponding to clinically relevant changes of GMFM without compromising muscular strength. Outcome correlates to GMFM and age rather than to MAS and maximal strength testing. The data of this evaluation suggest that children who benefit the most from SDR are between 4 and 7 years old and have a preoperative GMFM between 65% and 85%.
authors.affiliation: Department of Pediatric Orthopedic Surgery and Neuroorthopedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany. Electronic address: julia.funk@charite.de.
authors.forename: Julia F
authors.initials: JF
authors.lastname: Funk
authors.affiliation: Social Pediatric Center, Charité - University Medicine Berlin, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: Panthen
authors.affiliation: Department of Pediatric Orthopedic Surgery and Neuroorthopedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany.
authors.forename: M Sinan
authors.initials: MS
authors.lastname: Bakir
authors.affiliation: Department of Pediatric Orthopedic Surgery and Neuroorthopedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Gruschke
authors.affiliation: Social Pediatric Center, Charité - University Medicine Berlin, Germany.
authors.forename: Akosua
authors.initials: A
authors.lastname: Sarpong
authors.affiliation: Sana Hospital Lichtenberg, Social Pediatric Center, Berlin, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Wagner
authors.affiliation: Department of Pediatric Orthopedic Surgery and Neuroorthopedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Lebek
authors.affiliation: Division of Pediatric Neurosurgery, Charité - University Medicine Berlin, Germany.
authors.forename: Ernst Johannes
authors.initials: EJ
authors.lastname: Haberl
mesh_terms: D000367:Age Factors; D015992:Body Mass Index; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009048:Motor Skills; D009128:Muscle Spasticity / Q000601:surgery*; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000294:innervation* / Q000503:physiopathology; D018579:Patient Selection; D011446:Prospective Studies; D019051:Rhizotomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Cerebral palsy; Gross motor function measure; Muscular strength; Selective dorsal rhizotomy; Spasticity