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Original article
peer-reviewed

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later



Abstract

Background

Selective dorsal rhizotomy (SDR) is a surgical method used to treat childhood spastic cerebral palsy (CP). However, the effects of early SDR on functional outcomes and quality of life decades later in adulthood remains to be elucidated.

Objectives

To evaluate the long-term outcomes in terms of satisfaction and mobility of adult patients who received childhood SDR.

Methods

Adult patients who received SDR in childhood were surveyed. The survey questionnaire asked about demographic information, quality of life, health outcomes, SDR surgical outcomes, ambulation, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, and work status.

Results

Our study included 95 patients. The age that patients received SDR was between two and 18 years. The age at the time of survey was between 23 and 37 years (mean ± S.D., 30.2 ± 3.6 years). Post-SDR follow-up ranged from 20 to 28 years (mean ± S.D., 24.3 ± 2.2 years). Seventy-nine percent of patients had spastic diplegia, 20% had spastic quadriplegia, and one percent had spastic triplegia. Ninety-one percent of patients felt that SDR impacted positively the quality of life and two percent felt that the surgery impacted negatively the quality of life after SDR. Compared to pre-operative ambulatory function, 42% reported higher level of ambulation and 42% ambulated in the same level. Eighty-eight percent of patients would recommend the procedure to others and two percent would not. Thirty-eight percent reported pain, mostly in the back and lower limbs, with mean pain level 4.2 ± 2.3 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in patchy areas of the lower limbs that did not affect daily life was reported by eight percent of patients. Scoliosis was diagnosed in 31%. The severity of scoliosis is unknown. Only three percent of them underwent spinal fusion. Fifty-seven percent of patients required some orthopedic surgery after SDR. The soft-tissue tendon lengthening procedures included lengthening on hamstrings, Achilles tendons or adductors. Out of all bone procedures, 24% of patients had hip surgery, five percent had knee surgery, and 10% had derotational osteotomies. No late side effects of SDR surgery were reported in this survey.

Conclusions

In our 95 adult patients who received SDR in childhood, the surgery had positive effects on the quality of life and ambulation 20-28 years later. There were no late complications of SDR surgery.



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Original article
peer-reviewed

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later


Author Information

TS Park Corresponding Author

Neurological Surgery, Washington University School of Medicine, St. Louis Children's Hospital

Jenny L. Liu

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Caleb Edwards

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Deanna M. Walter

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Matthew B. Dobbs

Pediatric Orthopedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Institutional Review Board of Washington University School of Medicine issued approval 201509071. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

We would like to acknowledge Edward A. Hurvitz, MD and Deborah Gaebler-Spira, MD for sharing their survey questionnaire.


Original article
peer-reviewed

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later


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Original article
peer-reviewed

Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later

  • Author Information
    TS Park Corresponding Author

    Neurological Surgery, Washington University School of Medicine, St. Louis Children's Hospital

    Jenny L. Liu

    Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

    Caleb Edwards

    Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

    Deanna M. Walter

    Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

    Matthew B. Dobbs

    Pediatric Orthopedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Institutional Review Board of Washington University School of Medicine issued approval 201509071. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    We would like to acknowledge Edward A. Hurvitz, MD and Deborah Gaebler-Spira, MD for sharing their survey questionnaire.


    Article Information

    Published: May 17, 2017

    DOI

    10.7759/cureus.1256

    Cite this article as:

    Park T, Liu J L, Edwards C, et al. (May 17, 2017) Functional Outcomes of Childhood Selective Dorsal Rhizotomy 20 to 28 Years Later. Cureus 9(5): e1256. doi:10.7759/cureus.1256

    Publication history

    Received by Cureus: April 10, 2017
    Peer review began: May 02, 2017
    Peer review concluded: May 15, 2017
    Published: May 17, 2017

    Copyright

    © Copyright 2017
    Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

Selective dorsal rhizotomy (SDR) is a surgical method used to treat childhood spastic cerebral palsy (CP). However, the effects of early SDR on functional outcomes and quality of life decades later in adulthood remains to be elucidated.

Objectives

To evaluate the long-term outcomes in terms of satisfaction and mobility of adult patients who received childhood SDR.

Methods

Adult patients who received SDR in childhood were surveyed. The survey questionnaire asked about demographic information, quality of life, health outcomes, SDR surgical outcomes, ambulation, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, and work status.

Results

Our study included 95 patients. The age that patients received SDR was between two and 18 years. The age at the time of survey was between 23 and 37 years (mean ± S.D., 30.2 ± 3.6 years). Post-SDR follow-up ranged from 20 to 28 years (mean ± S.D., 24.3 ± 2.2 years). Seventy-nine percent of patients had spastic diplegia, 20% had spastic quadriplegia, and one percent had spastic triplegia. Ninety-one percent of patients felt that SDR impacted positively the quality of life and two percent felt that the surgery impacted negatively the quality of life after SDR. Compared to pre-operative ambulatory function, 42% reported higher level of ambulation and 42% ambulated in the same level. Eighty-eight percent of patients would recommend the procedure to others and two percent would not. Thirty-eight percent reported pain, mostly in the back and lower limbs, with mean pain level 4.2 ± 2.3 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in patchy areas of the lower limbs that did not affect daily life was reported by eight percent of patients. Scoliosis was diagnosed in 31%. The severity of scoliosis is unknown. Only three percent of them underwent spinal fusion. Fifty-seven percent of patients required some orthopedic surgery after SDR. The soft-tissue tendon lengthening procedures included lengthening on hamstrings, Achilles tendons or adductors. Out of all bone procedures, 24% of patients had hip surgery, five percent had knee surgery, and 10% had derotational osteotomies. No late side effects of SDR surgery were reported in this survey.

Conclusions

In our 95 adult patients who received SDR in childhood, the surgery had positive effects on the quality of life and ambulation 20-28 years later. There were no late complications of SDR surgery.



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TS Park, M.D., Professor

Neurological Surgery, Washington University School of Medicine, St. Louis Children's Hospital

For correspondence:
tspark@wustl.edu

Jenny L. Liu

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Caleb Edwards

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Deanna M. Walter

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Matthew B. Dobbs

Pediatric Orthopedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital

TS Park, M.D., Professor

Neurological Surgery, Washington University School of Medicine, St. Louis Children's Hospital

For correspondence:
tspark@wustl.edu

Jenny L. Liu

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Caleb Edwards

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Deanna M. Walter

Pediatric Neurosurgery, Washington University School of Medicine, St. Louis Children's Hospital

Matthew B. Dobbs

Pediatric Orthopedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital