Outcomes after selective dorsal rhizotomy for spastic cerebral palsy

Object: The purpose of this article was to review the published outcomes af ter selective dorsal rhizotomy (SDR) for treatment of spastic cerebral pals y. Methods: A literature search identified all articles related to outcomes after SDR. The outcomes were reviewed according to a paradigm developed by the National Center for Medical Rehabilitation Research (NCMRR). The quali ty of the evidence for each outcome was assessed using Sackett's criteria a nd the classification system developed by the Brain Trauma Foundation and t he American Association of Neurological Surgeons. Results: There is very st rong evidence for benefits of SDR in the impairment domain of the NCMRR cla ssification. SDR has been shown conclusively to decrease lower limb spastic ity and increase lower limb range of motion. There is strong, but not as co nclusive evidence that SDR has a positive impact in the functional limitati on dimension, with improvements in motor function, and in particular the Gr oss Motor Function Assessment (GMFM). There is a moderate degree of certain ty that SDR results in improvements in the disability dimension, as evidenc ed particularly by improvements in the Functional Independence Measure for Children (WeeFIM) and Pediatric Evaluation of Disability Inventory (PEDI). There is a moderate degree of certainty that SDR results in positive supras egmental effects, especially related to upper limb function and cognition. There is weak evidence that SDR may reduce the need for orthopedic procedur es in patients with spastic cerebral palsy, and the impact on hip subluxati on relative to the natural history of this problem is unclear. Conclusions: This information could help to define the role of SDR in the management of the child with spastic cerebral palsy, in the light of alternative therapi es, such as intrathecal baclofen and botulinum toxin, which have been intro duced more recently. It also reveals the need for further studies, particul arly dealing with quality of life and economic impact.