No support that early selective dorsal rhizotomy increase frequency of scoliosis and spinal pain \u2013 a longitudinal population-based register study from four to 25\u2009years of age

Annika Lundkvist Josenby,Lena Westbom

doi:10.1186/s12891-020-03782-5

Abstract

Spasticity interfering with gross motor development in cerebral palsy (CP) can be reduced with selective dorsal rhizotomy (SDR). Although reported, it is unknown if SDR surgery causes later spine problems. Using CP-registry data from a geographically defined population, the objectives were to compare frequency and time to scoliosis, and spinal pain up to adult age after SDR-surgery or not in all with same medical history, functional abilities, CP-subtype and level of spasticity at 4 years of age. Variables associated with scoliosis at 20 years of age were explored.MethodIn the total population with CP spastic diplegia in Skåne and Blekinge, born 1990–2006, 149 individuals had moderate to severe spasticity and no medical contraindications against SDR at 4 years of age and were included; 36 had undergone SDR at a median age of 4.0 years (range 2.5–6.6 years), and 113 had not.Frequency of scoliosis and age when scoliosis was identified, and frequency of spinal pain at 10, 15, 20 and 25 years of age were analysed using Kaplan-Meier survival curves and Fisher’s exact test. Multivariable logistic regression was performed to identify variables to explain scoliosis at 20 years of age. Gross Motor Function Classification System (GMFCS) levels at 4 years of age were used for stratification.ResultFrequency of scoliosis did not significantly differ between groups having had early SDR surgery or not. In GMFCS IV, the SDR group had later onset and lower occurrence of scoliosis (p = 0.004). Frequency of spinal pain did not differ between the groups (p- levels > 0.28). GMFCS level was the background variable that in the logistic regression explained scoliosis at 20 years of age.ConclusionFrequency of back pain and scoliosis in adulthood after early SDR are mainly part of the natural development with age, and not a surgery complication.

Highlights

Selective dorsal rhizotomy (SDR) is a neurosurgical procedure for children with spastic diplegic cerebral palsy (CP) that permanently reduces spasticity in the lower limbs by cutting parts of lumbosacral rootlets at spinal levels L2-S2
A higher proportion were SDR-operated in the first two birth cohorts than in the younger cohorts born from 1998 (p = 0.043). Another difference was a lower proportion of severe spasticity in the control group than in the SDR group (p = 0) (Table 1)
Two of the seven individuals in the non-SDR group Gross Motor Function Classification System (GMFCS) V assessed at 20 years of age had scoliosis

Summary

Introduction

Selective dorsal rhizotomy (SDR) is a neurosurgical procedure for children with spastic diplegic cerebral palsy (CP) that permanently reduces spasticity in the lower limbs by cutting parts of lumbosacral rootlets at spinal levels L2-S2. SDR is always combined with physical therapy, and it is mainly used in young children to improve future functional skills [1]. Neurosurgeons use either multilevel or single level laminotomy surgery to access the rootlets. As the intervention includes surgery to the spine and spinal nerve roots, there is a hypothetical risk that SDR will cause spinal deformities and pain may develop. The single level laminotomy technique was developed for the advantages of decreased time for surgery, postoperative pain and to minimize the risk of progressive lumbar instability [2]. In a short-term follow-up, no significant differences between the two techniques has been found [3]

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