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Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials

Published online by Cambridge University Press:  24 January 2002

John McLaughlin
Affiliation:
Children's Hospital and Regional Medical Center, Seattle, WA, USA.
Kristie Bjornson
Affiliation:
Children's Hospital and Regional Medical Center, Seattle, WA, USA.
Nancy Temkin
Affiliation:
Children's Hospital and Regional Medical Center, Seattle, WA, USA.
Paul Steinbok
Affiliation:
Children's and Women's Health Centre, Vancouver, BC, USA.
Virginia Wright
Affiliation:
Bloorview MacMillan Centre, Toronto, ON, Canada.
Ann Reiner
Affiliation:
Children's and Women's Health Centre, Vancouver, BC, USA.
Theodore Roberts
Affiliation:
Children's Hospital and Regional Medical Center, Seattle, WA, USA.
James Drake
Affiliation:
Hospital for Sick Children, Toronto, ON, Canada.
Maureen O'Donnell
Affiliation:
Children's and Women's Health Centre, Vancouver, BC, USA.
Peter Rosenbaum
Affiliation:
Bloorview MacMillan Centre, Toronto, ON, Canada.
Jason Barber
Affiliation:
University of Washington, USA.
Anne Ferrel
Affiliation:
Children's Hospital and Regional Medical Center, Seattle, WA, USA.
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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.

Type
Original Articles
Copyright
© 2002 Mac Keith Press

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