Long-term Outcomes of Selective Dorsal Rhizotomy Among Individuals With Cerebral Palsy
Condition: Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Observational

Summary: 
      Spasticity affects up to 80% of individuals diagnosed with cerebral palsy. Selective dorsal
      rhizotomy (SDR) is a surgical method used by some hospitals to permanently reduce spasticity
      in order to prevent further morbidities. Better understanding of the long-term outcomes of
      SDR is essential for clinicians and families. The results of this study will have direct
      clinical impact by equipping providers with the necessary information to counsel families
      during medical decision making.
    

Detailed description: 
      Spasticity affects up to 80% of individuals diagnosed with cerebral palsy. Excessive
      spasticity is thought to be uncomfortable, reduce function, cause gait deviations (e.g.
      equinus), and contribute toward musculoskeletal deformity and an elevated energy cost while
      walking. As such, SDR is a surgical method used by some hospitals to permanently reduce
      spasticity in order to prevent the aforementioned morbidities.

      Treatment philosophies differ widely in regards to how aggressively to manage spasticity.
      Some centers (e.g. Gillette) aggressively treat spasticity early in life through a variety of
      measures such as SDR, intrathecal baclofen pumps, and botulinum toxin injections. Other
      centers (e.g. Shriners Hospitals for Children - Salt Lake City and Spokane) offer little in
      the way of spasticity reduction treatments.

      There are several compelling reasons to conduct the proposed research study. First, emerging
      evidence suggests that the elimination of spasticity during childhood via SDR does not
      prevent contractures and only partially explains poor gross motor function, both previously
      thought to be clear outcomes of the surgery. Additionally, many of the longitudinal cohort
      studies that examined SDR outcomes have shown many outcome measures peak 1-3 years after
      surgery, and then decline toward baseline (i.e. pre-SDR) levels. Lastly, the quality of the
      SDR outcome literature is poor. Rarely are outcomes looked at in context of a proper control
      group. Either a control group is absent or comprised of typically developing children. This
      limits our ability to understand how patients with cerebral palsy may age without undergoing
      an SDR.

      Better understanding of the long-term outcomes of SDR is essential for clinicians and
      families. The surgery, in general, is costly to families (time, expense, risk, etc.) and
      clinicians should have every confidence in the intended outcomes for any intervention.
    

Intervention name(s): Gait and Motion Analysis; Gross Motor Function Measure (GMFM); Surveys
Intervention type(s): Diagnostic Test; Diagnostic Test; Behavioral
Intervention description(s): Gait and motion analysis is comprised of 3-dimensional kinematics and kinetics, electromyography, energy expenditure, and physical exam (range of motion, strength, spasticity, etc.); Gross Motor Function Measure (GMFM) is an assessment used to evaluate gross motor function over time in individuals with cerebral palsy. The assessment is comprised of movement activities like standing, walking, running, and jumping; Six surveys are used to assess function, activity, participation, pain, quality of life, and treatment history
Observational model: Case-Control
Time perspective: Other
Sampling method: Non-Probability Sample
Study population: 
        Former/current patients at Gillette Children's Specialty Healthcare, Shriners Hospitals for
        Children - Salt Lake City, or Shriners Hospitals for Children - Spokane
      
Keywords: Selective Dorsal Rhizotomy; Outcomes