Efficacy and influencing factors of selective dorsal rhizotomy for the treatment of spastic cerebral palsy in children

Abstract

Objective To analyze clinical efficacy and influencing factors of selective dorsal rhizotomy (SDR) for treatment of spastic cerebral palsy (SCP) in children. Methods Total 131 children with SCP who underwent SDR at Shanghai Children's Hospital between September 2015 and June 2019 were included in the study. The Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure-66 Items (GMFM-66) were used to evaluate the gross motor function before surgery and at the last follow-up. The modified Ashworth Scale was used to assess the degree of spasticity in the target muscle groups of the lower limbs. Univariate and multivariate Logistic regression analyses were performed to identify the influencing factors of the improvement in GMFM -66 score. Results Compared to preoperative values, there was a significant decrease in muscle tonus in the target muscle groups of the lower limbs after surgery, including bilateral adductors muscles (Z = -8.164, P = 0.000; Z = -8.304, P = 0.000), bilateral hamstrings muscles (Z = -7.424, P = 0.000; Z = -7.123, P = 0.000), bilateral gastrocnemius muscles (Z = -9.328, P = 0.000; Z = -9.605, P = 0.000), and bilateral tibialis anterior muscles (Z = -9.349, P = 0.000; Z = -9.543, P = 0.000). The overall improvement rate of GMFCS classification after surgery was 34.35% (45/131), and there were no cases of GMFCS classification worsening. There were statistically significant differences in GMFM -66 scores before and after surgery among different GMFCS levels (F = 215.030, P = 0.000). The improvement in GMFM -66 score was greater in GMFCS level Ⅰ (t = 4.379, P = 0.000), Ⅱ (t = 3.686, P = 0.000) and Ⅲ (t = 3.198, P = 0.002) compared to level Ⅳ , and levelⅠ had better score than level Ⅲ (t = 2.170, P = 0.032). Logistic regression analysis showed that surgery performed at the age of 3-6 years (OR = 4.917, 95%CI: 1.554-15.557; P = 0.007) and preoperative GMFCS level Ⅰ - Ⅲ (OR = 10.294, 95%CI: 3.522- 30.092; P = 0.000) were favorable factors for a ΔGMFM -66 score improvement of ≥ 6.55 score. Conclusions SDR effectively reduces muscle tonus in the target muscle groups of the lower limbs and improves gross motor function in children with SCP. The treatment outcome is particularly favorable for children with increased muscle tonus in both lower limbs who can cooperate with rehabilitation training (GMFCS level Ⅰ-Ⅲ). SDR can also be considered for children with severe cerebral palsy (GMFCS level Ⅳ-Ⅴ) to facilitate daily care.

DOI: 10.3969/j.issn.1672-6731.2023.05.005