Orthopedic surgery after selective dorsal rhizotomy in children with cerebral palsy: A matched cohort study.

Abstract

Aim: To test whether selective dorsal rhizotomy (SDR) changes the incidence of subsequent orthopedic surgery in children with cerebral palsy.

Method: This was a matched cohort study. Using historical data from a single center, we identified two groups of individuals based on their history of SDR (yes-SDR and no-SDR), matched at baseline on key clinical variables. We defined 10 orthopedic surgery categories that accounted for more than 95% of surgery recorded in our gait center database. We then fitted Kaplan-Meier estimates of cumulative incidence for each surgery, stratified according to SDR status.

Results: We obtained excellent comprehensive baseline matching. Foot and ankle bone surgery and femoral derotation osteotomy exhibited 15% to 20% higher cumulative incidence after SDR. Rectus femoris transfer exhibited approximately 30% lower cumulative incidence after SDR. The remaining surgeries, including all surgeries for treating muscle contractures, were unaffected by SDR, exhibiting only small (<15%) or nonsignificant (p > 0.05, log-rank test) differences in cumulative incidence.

Interpretation: SDR does not consistently lower the cumulative incidence of orthopedic surgery and does not lower the rate of surgery for muscle contracture. The mechanisms through which SDR influences subsequent surgery remain unclear, highlighting a critical area for future research.