The Australian selective dorsal rhizotomy registry-characteristics of children with cerebral palsy who have selective dorsal rhizotomy

Abstract

Objective: To describe the characteristics of Australian children who have had selective dorsal rhizotomy (SDR) surgery Design: Retrospective and prospective cohort study of data entered into the Australian Selective Dorsal Rhizotomy Registry Method: This study forms part of an ongoing multicentre national research registry involving five tertiary paediatric hospitals involved in SDR management across Australia. Participants included all children whose parents consented for data to be entered into the registry comprising children who have undergone SDR in Australia or internationally. Data pertaining to demographic, diagnosis, cerebral palsy (CP) classifications, physical assessment at baseline and surgery are described. Results: We identified 62 children (37 male) who have had SDR residing in Australia. Children reside in many of the states and territories. Forty-two children had SDR surgery in Australia and 20 internationally (19 in the US). Sixty-one children had a diagnosis of CP. Forty-seven were born premature. Periventricular leukomalacia was the most common finding on brain MRI (51 cases). Forty-seven children were identified to have diplegia, 15 triplegia or quadriplegia. The mean (SD) age at surgery was 5 years 11 months (16 months) (range 3 years 6 months-11 years 5 months). Spasticity was the predominant movement disorder for most (n=56) children prior to surgery, with mixed spasticity and dystonia noted in 6. Spasticity as measured by Modified Ashworth Scale (MAS) was typically noted at multiple levels in the lower limbs including hip adductors (median MAS 2), hamstrings (median MAS 2) and gastrocnemii (median MAS 3). Children had average (median) lower limb strength as graded by manual muscle testing of 3/5 in hip abductors, 3/ 5 in hip extensors, and 4/5 in knee extensors. Selective (motor) control assessment of the lower limbs (SCALE) was an average (median) of 4. Some degree of scoliosis was present prior to surgery in 6 children, kyphosis in 1 and excess lumbar lordosis in 2. Most children were classified as Gross Motor Function Classification System III (n=33, 54%) or II (n=19, 31%), with a minority IV (n=7, 11%) or I (n=2, 3%). Mean Gross Motor Function Measure (GMFM-66) was 57.3 (SD 10.9). Conclusion: Children who have had SDR surgery in Australia largely conform to the established 'Peacock' selection criteria. More evidence is required to support decision making around the role of SDR for children who do not meet these criteria.L6316058622020-05-04 <br />