Selective dorsal rhizotomy: meta-analysis of

three randomized controlled trials

Published online by Cambridge University Press:  24 January 2002

John McLaughlin,
Kristie Bjornson,
Nancy Temkin,
Paul Steinbok,
Virginia Wright,
Ann Reiner,
Theodore Roberts,
James Drake,
Maureen O'Donnell,
Peter Rosenbaum
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; Wilcoxon p<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.

Changes in hip spasticity and strength

following selective dorsal rhizotomy and
physical therapy for spastic cerebral palsy
Published online by Cambridge University Press:  09 May 2002

Jack R Engsberg,
Sandy A Ross,
Joanne M Wagner and
T S Park
Abstract
Hip adductor spasticity and strength in participants with cerebral palsy (CP) were
quantified before and after selective dorsal rhizotomy (SDR) and intensive physical
therapy. Twenty-four participants with cerebral palsy (CP group) and 35 non-
disabled participants (ND controls) were tested with a dynamometer (CP group:
mean age 8 years 5 months, 13 males, 11 females; ND group: mean age 8 years 6
months, 19 males, 16 females). According to the Gross Motor Function
Classification System (GMFCS), of the 24 participants with CP, eight were at level
I, six were at level II, and 10 participants were at level III. For the spasticity
measure, the dynamometer quantified the resistive torque of the hip adductors
during passive abduction at 4 speeds. The adductor strength test recorded a
maximum concentric contraction. CP group spasticity was significantly reduced
following SDR and adductor strength was significantly increased after surgery.
Both pre- and postoperative values remained significantly less than the ND
controls. Spasticity results agreed with previous studies indicating a reduction.
Strength results conflicted with previous literature subjectively reporting a
decrease following SDR. However, results agreed with previous objective
investigations examining knee and ankle strength, suggesting strength did not
decrease following SDR.