The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children With Cerebral Palsy: A Long-term Follow-up Study

Stacey D Miller; Emma Lewis; Jonathan Lau; Maria Juricic; Vuong Nguyen; Paul Steinbok; Firoz Miyanji; Kishore Mulpuri

doi:10.1097/BPO.0000000000002878

The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children With Cerebral Palsy: A Long-term Follow-up Study

J Pediatr Orthop. 2024 Dec 5. doi: 10.1097/BPO.0000000000002878. Online ahead of print.

Authors

Stacey D Miller^{1

2

3}, Emma Lewis¹, Jonathan Lau⁴, Maria Juricic^{1

2

3}, Vuong Nguyen³, Paul Steinbok⁵, Firoz Miyanji^{1

3

6}, Kishore Mulpuri^{1

3

6}

Affiliations

¹ BC Children's Hospital, Vancouver, BC.
² Department of Physical Therapy, University of British Columbia.
³ BC Children's Hospital Research Institute, Vancouver, BC.
⁴ The Children's Hospital of Winnipeg, Winnipeg, MB, Canada.
⁵ Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia.
⁶ Department of Orthopaedics, University of British Columbia.

PMID: 39636007
DOI: 10.1097/BPO.0000000000002878

Abstract

Background: Selective dorsal rhizotomy (SDR) is commonly used to reduce spasticity in children with cerebral palsy (CP). Children with CP have an increased risk of spinal deformities that increase with age and Gross Motor Function Classification System (GMFCS) level. Few studies have considered the risk of spinal deformity post-SDR by GMFCS level. The purpose of this review was to evaluate the incidence and severity of spinal deformities in children with CP, overall and by GMFCS level, a minimum of 5 years after SDR.

Methods: In this retrospective review, participants included all those who had an SDR before January 1, 2013, at a Canadian pediatric hospital. Participants had to have a spine radiograph preoperatively and a minimum 5 years post-SDR. Age, GMFCS level, level of laminectomy, percentage of rootlets cut, and orthopaedic surgical history were collected. Scoliosis was evaluated using coronal curve and was measured pre-SDR and a minimum 5 years post-SDR or until spine surgery. When available, sagittal plane radiographs were reviewed.

Results: A total of 107 participants (61 male, 46 female), at GMFCS levels I to V (2,25,22,45, and 13, respectively) were included. The mean age at SDR was 4.8 years (SD 1.5), with a mean follow-up of 12.7 years (SD 4.9). Post-SDR, 57 (53%) participants had scoliosis, with the major curve averaging 46 degrees (SD 34.9). Scoliosis measuring >10 degrees was found in 8 (32%) participants at level II, 4 (18%) at level III, 33 (73%) at level IV and 12 (92%) at level V. No participants at GMFCS levels I to III, and 35% and 67% of those at levels IV and V, respectively, had a curve magnitude >40 degrees. Of those who had lateral imaging, 38% had excessive kyphosis, 21% hyperlordosis, and 16% spondylolisthesis.

Conclusions: The rate of scoliosis is consistent with the natural history of children with CP without surgical intervention as reported in the literature when compared by GMFCS level and curve severity.

Level of evidence: Level IV.