Selective dorsal rhizotomy – the treatment of choice for cerebral palsy spasticity in non-ambulant GMFCS IV children?

Abstract

OBJECTIVES: Selective dorsal rhizotomy (SDR) is established for ambulant children with cerebral palsy (CP), but its role in non-ambulant children remains debated. We evaluated two-year clinical and functional outcomes of SDR in GMFCS IV children. METHODS: A retrospective cohort study of SDR (2013-2022) at a tertiary paediatric neurosurgical centre was performed. Children with significant spasticity were included; those with severe dystonia or genetic/metabolic causes were excluded. Of 41 GMFCS IV patients, 30 had ≥2-year follow-up. Outcomes included Modified Ashworth Scale (MAS), range of motion (ROM), Gross Motor Function Measure (GMFM-88, GMFM-66), CP Quality of Life (CP QOL-Child), and need for orthopaedic surgery. Associations with prematurity and MRI findings were analysed using non-parametric tests. RESULTS: All children showed sustained spasticity reduction with significant MAS improvement at one and two years. Hip abduction and ankle dorsiflexion improved, while popliteal angle decreased. GMFM-88 and GMFM-66 improved at 6 months and 2 years (P<0.001). Dystonia remained stable. No SDR-related complications occurred. Five children (16.7%) required orthopaedic surgery. Outcomes were not associated with prematurity or MRI findings. CONCLUSIONS: SDR is safe and effective in GMFCS IV children, providing functional and quality-of-life gains, and may be a cost-effective alternative to intrathecal baclofen in selected patients.