Selection of Children with Spasticity Other Than Cerebral Palsy: Indications, Long-Term Outcome, and Exclusion Criteria.

Abstract

Background: Selective dorsal rhizotomy (SDR) has been instrumental in improving functionality and mitigating lower extremity spasticity originating from a myriad of central nervous system (CNS) etiologies. Existing literature on SDR extensively discusses its utility in cerebral palsy (CP)-associated spasticity management. There is a void on the utility and guidance in patient selection for SDR in pediatric patients with non-CP-related spasticity.

Methods: A systematic review was performed on studies describing SDR outcomes in pediatric patients identified from Medline and Embase databases. Publications between January 1970 and August 2023 were included. Combinations of search terms "selective dorsal rhizotomy," "selective posterior rhizotomy," and "spasticity" were utilized. Pediatric patient studies with clinical data on spasticity, ambulation, procedural variables, and follow-up outcomes were included. Articles including patients without cerebral palsy as a primary diagnosis were reviewed in detail for outcomes after intervention.

Results: A total of 114 publications were identified, and of these, 11 fit inclusion criteria for a total of 127 patients. Most common non-CP etiologies for spasticity included hereditary spastic paraparesis (27.8%, n = 34), congenital syndrome (n = 7), and spinal cord injury (21.9%, n = 6). Compared to their baseline, SDR in non-CP-related etiologies demonstrated tone normalization (93%, n = 43 out of 45 patients) in most and improvement in ambulation (49.2%, n = 58 out of 118 patients) in a significant proportion of patients.

Conclusion: This systematic review on SDR in pediatric patients revealed effective spasticity control and improvement in ambulatory functionality in selected patients without cerebral palsy. Appropriate patient selection is keystone in achieving sustained benefits in functionality and quality of life.