Rehabilitative Outcome after Selective Dorsal Rhizotomy (SDR)

The term cerebral palsy (CP) subsumes developmental disorders, which are due to an irreversible but non-progressive disturbance of the developing brain. CP is one of the most common causes of chronic disability in childhood. The spastic form predominates by far, in its lighter manifestation usually termed bilateral, spastic CP. Children with a bilateral, spastic CP benefit, on one hand, from orthotics, which support the weak extensors, as well as procedures such as the intramuscular application of botulinum toxin, which is intended to reduce the relative overweight of flexors.

Selective dorsal rhizotomy (SDR) is an operative method in which under intraoperative electrophysiological control dorsal rootlets, with a hyperactive response are transected. This leads to a reduction in spasticity.

We retrospectively examined data from 100 children undergoing SDR from 2009 to 2014 at the Charité Universitätsklinik Berlin due to bilateral, spastic CP.

Prior to and after selective dorsal rhizotomy, measurements were undertaken using the GMFM88, Modified-Ashworth-scale, Tardieu, selective mobility, and quality of life questionnaires at the postoperative time points for 3, 6, 12, and 24 months.

In all children postoperatively, a reduction of spasticity and new possibilities of movement were observed postoperatively. These results in gait-improvement and an extension of the possible walking distance in the majority of patients. In more than 80% of the children, these effects also persist over the 24-month period.

The purpose of further studies is to identify factors that can have a positive or negative effect on the rehabilitative outcome according to SDR.