Predictors for the benefit of selective dorsal rhizotomy.
GMFM scores between 65-a large share at predict the biggest, safest gains from selective dorsal rhizotomy.
01Research in Context
What this study did
The team followed the kids with spastic cerebral palsy for two years after selective dorsal rhizotomy.
All children had the same surgery at one hospital.
Doctors tracked spasticity, strength, and the Gross Motor Function Measure every six months.
What they found
Kids who started at GMFM 65-meaningful improvemented the most movement.
Their spasticity dropped and stayed low without losing leg strength.
Children outside this age-and-skill window improved less.
How this fits with other research
Eussen et al. (2016) also show timing matters: early knee hyperextension fixes better than late.
Together the papers say "hit the right window" for any CP surgery.
Bleyenheuft et al. (2013) found sensory gaps limit hand use; F et al. now add that motor-only scores like MAS miss the best SDR candidates.
Use GMFM, not just MAS, to pick kids.
Why it matters
You can spot the best SDR candidates in clinic tomorrow.
Grab the GMFM-66. If the child is 4-7 years and scores 65-a large share, refer for rhizotomy.
Skip the referral if the score is above a large share or below a large share—gains are small.
Add this one cut-off to your intake packet and save families a long trip to the surgeon.
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02At a glance
03Original 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%.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2014.11.012