Long-term Outcomes of Selective Dorsal Rhizotomy Among Individuals With Cerebral Palsy
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 1/2/2019 |
| Start Date: | November 1, 2018 |
| End Date: | December 2020 |
Long-term Outcomes of Selective Dorsal Rhizotomy Among Individuals With Cerebral Palsy Compared to a Matched Control Group
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.
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.
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.
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.
Inclusion Criteria for Controls (-SDR) and Cases (+SDR):
- Able to speak and read English
- Diagnosed with bilateral cerebral palsy (i.e. no hemiplegics)
- Minimum age of 21 years presently
- Had a baseline gait and motion analysis
Controls (-SDR):
- No SDR
- No history of intrathecal baclofen (ITB) pump implantation for > 1 year
- No ITB pump at time of long-term follow-up (explant > or = 6 months)
- No history of oral baclofen for > 1 year
- No oral baclofen use at time of long-term follow-up
- No more than 10 sessions on botulinum toxin, phenol, or alcohol injection
Cases (+SDR):
- History of SDR > 5 years ago
- Had a baseline gait analysis < or = 18 months before SDR
Exclusion Criteria:
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