Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials
John McLaughlin, Kristie Bjornson, Nancy Temkin, Paul Steinbok, Virginia Wright, Ann Reiner, Theodore Roberts, James Drake, Maureen O'Donnell, Peter Rosenbaum, Jason Barber, Anne Ferrel, John McLaughlin, Kristie Bjornson, Nancy Temkin, Paul Steinbok, Virginia Wright, Ann Reiner, Theodore Roberts, James Drake, Maureen O'Donnell, Peter Rosenbaum, Jason Barber, Anne Ferrel
Abstract
This study is a comparative analysis and meta-analysis of three randomized clinical trials. Children with spastic diplegia received either 'selective' dorsal rhizotomy (SDR) plus physiotherapy (SDR+PT) or PT without SDR (PT-only). Common outcome measures were used for spasticity (Ashworth scale) and function (Gross Motor Function Measure [GMFM]). Baseline and 9- to 12-month outcome data were pooled (n=90). At baseline, 82 children were under 8 years old and 65 had Gross Motor Function Classification System level II or III disability. Pooled Ashworth data analysis confirmed a reduction of spasticity with SDR+PT (mean change score difference -1.2; Wilcoxonp<0.001). Pooled GMFM data revealed greater functional improvement with SDR+PT (difference in change score +4.0, p=0.008). Multivariate analysis in the SDR+PT group revealed a direct relationship between percentage of dorsal root tissue transected and functional improvement. SDR+PT is efficacious in reducing spasticity in children with spastic diplegia and has a small positive effect on gross motor function.
Source: PubMed