A Mixed Methods Study of Practice Variation in Selective Dorsal Rhizotomy: A Study by the Cerebral Palsy Research Network

Abstract

BackgroundSelective dorsal rhizotomy (SDR) is an established procedure for the treatment of spasticity associated with cerebral palsy (CP). With the indications for the procedure expanding, we aimed to investigate provider perception about SDR candidates against the characteristics of those undergoing SDR in the CP Research Network (CPRN) registry. MethodsThis was a mixed methods study. Descriptive data on 2486 individuals in the CPRN registry and results of semistructured interviews with 41 providers about the effect of age, Gross Motor Function Classification System (GMFCS) level, and dystonia on consideration for SDR are reported. ResultsSDR was performed in 238 individuals, majority aged eight to 12 years (n = 105), GMFCS level II (n = 46), and white (n = 183). Most neurosurgeons perform a single-level SDR. Providers believe the majority of individuals undergoing SDR are between five and six years and GMFCS level II with variable agreement. There was no significant agreement about the youngest age (P = 0.451) or ideal GMFCS level (P = 0.451) for SDR. Providers had agreement on the oldest age for SDR (P = 0.041), how to screen for dystonia (P < 0.001), and dystonia as a contraindication for SDR (P < 0.0005). ConclusionsProviders show variation in regard to what they believe the youngest age or ideal GMFCS level is for SDR but agree on performing SDR in older age groups, screening for dystonia with a neurological examination, and being less likely to perform SDR in the presence of dystonia.