Predictors of outcome in patients with cerebral palsy following selective dorsal rhizotomy

Max Weinbrecht-Mischkewitz; Elisa Wittmack; Franziska Hentschel; Akosua Sarpong-Bengelsdorf; Julia Funk; Matthias Schulz; Simone Wolter; Joanna Schneider; Ulrich-Wilhelm Thomale; Angela M Kaindl; Petra Bittigau; Anne K van Riesen

doi:10.1016/j.earlhumdev.2024.106154

Predictors of outcome in patients with cerebral palsy following selective dorsal rhizotomy

Early Hum Dev. 2025 Jan:200:106154. doi: 10.1016/j.earlhumdev.2024.106154. Epub 2024 Nov 22.

Affiliations

¹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
² Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
³ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
⁴ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
⁵ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Department of Pediatric Orthopedic Surgery and Neuroorthopedics, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
⁶ German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
⁷ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
⁸ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, German Epilepsy Center for Children and Adolescents, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
⁹ German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
¹⁰ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, German Epilepsy Center for Children and Adolescents, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Cell- and Neurobiology, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: [email protected].
¹¹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Augustenburger Platz 1, 13353 Berlin, Germany; German Center for Child and Adolescent Health (DZKJ), section CNS development and neurologic disease, partner site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: [email protected].
¹² Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Chronically Sick Children, Augustenburger Platz 1, 13353 Berlin, Germany.

PMID: 39615367
DOI: 10.1016/j.earlhumdev.2024.106154

Abstract

Background: To identify outcome predictors of selective dorsal rhizotomy (SDR) in children with spastic cerebral palsy (CP) using logistic regression models.

Methods: A retrospective single-center study was conducted on children with spastic CP who had undergone SDR. Two outcomes were defined, one representing children not improving in motor function and spasticity and one representing children improving in motor function two years after surgery. Baseline variables were chosen based on established regressors and clinical considerations and tested for being predictors using multivariate logistic regression.

Results: We included 96 patients (mean age [SD] 6y 9 m [2y 5 m], range 2y to 17y) in the study. Significant predictors of non-improvement in motor function and spasticity two years after SDR were higher age at surgery and higher preoperative Gross Motor Function Measure-88 (GMFM-88) score. Significant predictors of motor function improvement after SDR were lower preoperative Modified Ashworth Scale (MAS) scores, higher preoperative passive range of motion (pROM) and lower age at surgery.

Conclusions: For the first time, pROM and preoperative spasticity were identified as predictors of SDR outcome. We confirmed motor function and age as predictors. These variables will be useful for future patient selection. Adjusting for the GMFM-88's ceiling effect, children with higher motor function can still profit significantly from SDR.

Keywords: Cerebral palsy; Motor function; Predictors of outcome; Selective dorsal rhizotomy; Spasticity.

MeSH terms

Adolescent
Cerebral Palsy* / surgery
Child
Child, Preschool
Female
Humans
Male
Muscle Spasticity / etiology
Muscle Spasticity / surgery
Retrospective Studies
Rhizotomy* / methods
Treatment Outcome