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

Abstract

The effect of a selective dorsal rhizotomy (SDR) on the incidence of subsequent orthopedic surgery is unknown. Proponents of SDR often assert that the procedure lowers the need for orthopedic surgery, including surgery to address muscle contractures. There is no strong evidence to support this claim. Conversely, a recent, multi-center study evaluating the long-term effects of SDR suggested the procedure might increase the rate of subsequent orthopedic surgery. However, the study design could not account for differences in treatment philosophy between centers, which could have influenced the findings.

In the current study, we estimated the effect of an SDR on the cumulative incidence of undergoing each of 10 common orthopedic surgeries. We used historical data from patients with and without a history of SDR (Yes-SDR, No-SDR) who received care at a center that offers SDR as part of a proactive spasticity management philosophy. We carefully matched limbs at baseline on indications for an SDR. We then used Kaplan–Meier analysis—a common statistical method that estimates the proportion of patients who have not yet experienced an event, like surgery, at different points in time—to compute the cumulative incidence of each of the surgeries as a function of age.

Our results show that SDR does not consistently lower the incidence of orthopedic surgery. We found a higher cumulative incidence of orthopedic surgery in the Yes-SDR group for femoral derotation osteotomy and foot and ankle bone surgery. We found a lower cumulative incidence for rectus femoris transfer. We found no difference for any contracture relieving surgery (hamstrings, calf muscle, psoas, adductor), tibial derotation osteotomy, foot and ankle soft tissue surgery, or surgery to address crouch gait (distal femoral extension osteotomy or patellar tendon advancement).