Orthopedic surgery after selective dorsal rhizotomy in children with cerebral palsy: A matched cohort study.

This is a retrospective observational study, not a randomised trial, so it cannot prove SDR caused the surgery differences. Surgery decisions may reflect surgeon beliefs, patient preferences, or referral reasons, not only physical impairment. Some patients were censored because care was stopped when their condition was judged mild, and yes-SDR limbs were followed longer on average, which can bias surgery incidence. Matching was comprehensive but not perfect; the yes-SDR group was 6 months younger at baseline, and the authors accepted some differences above their target matching threshold. The study included only people with bilateral spastic CP at GMFCS level I, II, or III who had gait analysis, so it may not apply to more severe or unilateral CP. The decision to perform SDR at this center involved multidisciplinary judgment and quantitative data, so undocumented factors may still differ between groups. Adherence to the center's own SDR selection criteria was below 100%, for example 78% for purely spastic tone and 60% for energy cost of transport. More than 90% of surgeries were part of multilevel orthopedic treatment, so surgery categories are not independent and cannot be added together. Femoral derotation osteotomy may be done for alignment or hip dysplasia, but the study could not separate these reasons. The study used a center-specific database and a 15% difference threshold to call a result clinically meaningful, so findings may not generalise to other services.

Do not read this as evidence that SDR prevents later orthopedic surgery. It was followed by fewer rectus femoris transfers, but not by clear reductions in contracture or crouch surgeries, and bony foot and femoral derotation surgeries were higher. The study is observational, and surgery decisions may also reflect surgeon and patient preferences.