Long-term effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review.
Kristina Tedroff, Gunnar Hägglund, Freeman Miller
PMID 31342516WHAT IT FOUND
Selective dorsal rhizotomy in children with cerebral palsy did not show better long-term function than routine therapy and orthopaedic care.
Spasticity reduction often persisted, but some needed additional antispasticity treatment.
Key findings
0110 years or more of follow-up did not indicate that functional improvement after selective dorsal rhizotomy was better than routine therapy and orthopaedic management.
02Seven studies that evaluated spasticity reported sustained long-term reduction or normal tone, but five articles noted a need for additional antispasticity treatment.
03The 16 included studies had low evidence level and medium to high risk of bias.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included only observational studies and no randomized controlled trials. The included studies had small samples and many had substantial loss to follow-up. Baseline function was often classified retrospectively, which can introduce detection bias. Outcome measures were heterogeneous, so results could not be pooled statistically. Complications were reported inconsistently, and some complication rates may be over- or underestimated. Spinal deformity reports often used imaging before skeletal maturity, so long-term risk is unclear. The authors did not assess risk of bias for the complication reports.
The easy way to misread this
Do not conclude that selective dorsal rhizotomy reliably improves long-term function. The review found no functional benefit better than routine therapy and orthopaedic management, and the evidence was low quality with medium to high risk of bias.