Functional outcomes of childhood dorsal rhizotomy in adults and adolescents with cerebral palsy

Clinical article

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  • 1 Departments of Physical Medicine and Rehabilitation, and
  • | 3 Neurosurgery, University of Michigan, Ann Arbor, Michigan; and
  • | 2 Department of Physical Medicine and Rehabilitation, Feinberg Medical School, Rehabilitation Institute of Chicago, Northwestern University, Chicago, Illinois
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Object

In this descriptive study the authors evaluated medical outcomes, interventions, satisfaction with life, and subjective impressions about selective dorsal rhizotomy (SDR) in older adolescents and adults who had undergone the procedure as children.

Methods

A survey was administered to older adolescents (16–20 years old) and adults with CP who had undergone SDR between 1986 and 2000 at two academic centers. The patients or their caregivers participated in telephone or clinic interviews. Subjective impressions about the SDR and a history of post-SDR medical interventions were obtained. Current functional status, history and ratings of pain, educational achievement, living situation, and subjective health status were also recorded. The Diener Satisfaction with Life Scale (SWLS) was administered.

Results

Eighty-eight participants, mean age 25.6 ± 4.8 years (mean ± standard deviation), were interviewed at a mean of 19.6 ± 3.0 years after surgery. The distribution of current reported Gross Motor Function Classification System levels was as follows: I, 7%; II, 18%; III, 23%; IV, 36%; and V, 16%. Moreover, 56% of respondents were living with parents and 25% were living alone. Thirty-five percent were employed, and 39% were still in school. The mean overall SWLS score was 26.0 ± 7.3, indicating a high level of satisfaction with life. According to 65% of the patients, the SDR was helpful; 31% were uncertain about the procedure's efficacy. Sixty-five percent would recommend the procedure to others. Fifty-eight percent reported excellent to very good health. Forty-four percent reported pain in the past week. Fifty-one percent reported chronic back pain in general. Logistic regression analysis suggested that an increased satisfaction with life was a predictor (p = 0.01) of an affirmative response to the question about recommending the procedure to others and that better overall health showed a trend toward being such a predictor (p = 0.08). Additional interventions were frequently performed after the SDR. Seventy-four percent of participants underwent orthopedic surgery. Thirty-eight percent were currently taking oral medications for tone, and 53% had received botulinum toxin injections for spasticity treatment. Thirteen patients (15%) had an intrathecal baclofen pump placed.

Conclusions

The majority of adults who had undergone SDR as children would recommend the procedure to others. Very few reported negative impressions of the procedure. Levels of satisfaction with life were generally high. Pain prevalence was similar to what has been reported in the literature for adults with cerebral palsy. Despite the SDR, further interventions, both surgical and nonsurgical, were used in the majority of patients.

Abbreviations used in this paper:

ADL = activity of daily living; CP = cerebral palsy; GMFCS = Gross Motor Function Classification System–Expanded and Revised; MACS = Manual Ability Classification System; NRS = Numeric Rating Scale; QOL = quality of life; RIC = Rehabilitation Institute of Chicago; SDR = selective dorsal rhizotomy; SF-36 = 36-Item Short-Form Health Survey; SWLS = Satisfaction with Life Scale; UMHS = University of Michigan Health System.

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