A long-term follow-up study of spinal abnormalities and pain in adults with cerebral palsy and spastic diplegia more than 25 years after selective dorsal rhizotomy

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  • 1 Department of Surgery, Division of Neurosurgery and Neuroscience Institute, University of Cape Town;
  • 2 Department of Surgical Sciences, Division of Orthopaedic Surgery, Stellenbosch University, Cape Town; and
  • 3 Winelands Radiology, Institute of Orthopaedics and Rheumatology, Winelands Orthopaedic Hospital, Stellenbosch, Western Cape, South Africa
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OBJECTIVE

The main purpose of selective dorsal rhizotomy (SDR) is to reduce spasticity in the lower extremities of children diagnosed with cerebral palsy (CP) and spastic diplegia. The potential for developing spinal abnormalities and pain is a concern, especially in the aging CP population. Therefore, the aim of this study was to evaluate spinal abnormalities, level of pain, and disability (due to back or leg pain) in adults with CP, and associations with participant characteristics, more than 25 years after SDR.

METHODS

This is a 9-year follow-up study with data collection conducted in 2008 and 2017. Radiographs were assessed for the degree of scoliosis, thoracic kyphosis and lumbar lordosis curvatures, and prevalence of spondylolysis and spondylolisthesis, while level of pain and disability was determined with a self-developed questionnaire and the Oswestry Disability Index (ODI) questionnaire, respectively.

RESULTS

Twenty-five participants were included (15 males; median age 35.9 years, IQR 34.3–41.5 years), with a follow-up time after SDR ranging from 25 to 35 years. No clinically relevant changes were found for spinal curvatures, spondylolysis and spondylolisthesis, perceived pain frequency, and ODI scores between 2008 and 2017. While the prevalence of spondylolysis was 44%, spondylolisthesis was found in 20% (of whom 15% were grade I and 5% grade II), lumbar hyperlordosis was found in 32%, thoracic hyperkyphosis in 4%, and scoliosis in 20%. The Cobb angle was < 25°, and no patient required surgery for scoliosis. In addition, the low back was reported as the most common site of pain, with 28% of the adults with CP having daily pain. This resulted in 80% of the cohort indicating none or minimal disability due to pain based on the ODI. The only correlation found was between hyperkyphosis and female gender.

CONCLUSIONS

At follow-up more than 25 years after SDR, no progression in spinal abnormalities, level of pain, and disability was found when compared with findings 15 years after SDR. The prevalence of scoliosis, thoracic hyperkyphosis, and lumbar hyperlordosis was within the range reported for adults with CP, while spondylolysis and spondylolisthesis occurred more often than would be expected. It is difficult, however, to establish the role of SDR in this finding, given the limited data on the natural history of CP. Despite the encouraging outcome of this long-term follow-up study after SDR, it is important to continue monitoring adults with CP during the aging process.

ABBREVIATIONS CP = cerebral palsy; GMFCS = Gross Motor Function Classification System; MCID = minimal clinically important difference; ODI = Oswestry Disability Index; SDR = selective dorsal rhizotomy; SES = socioeconomic status.

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Contributor Notes

Correspondence Nelleke G. Langerak: University of Cape Town, Western Cape, South Africa. nellekelangerak@hotmail.com.

INCLUDE WHEN CITING Published online October 16, 2020; DOI: 10.3171/2020.6.SPINE20751.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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