Long Term Impact of Selective Dorsal Rhizotomy

Alecia Daunter MD, Anna Kratz PhD, Edward Hurvitz MD

Disclosures• 2013 Gabriella E. Molnar-Swafford Pediatric

Research Grant, Foundation for PM&R

The Problem• What is the long term impact of SDR?• How do people who had the procedure

compare to those who did not?

What We Add• Long(er) term• Relatively large N• Control group • Unique outcomes

Primary Outcomes• Pain• Fatigue• Change in function

Study Design• Case control design• Internet survey

Surgical Group

Control Group

Study Groups

All subjects (n = 88)•Adults ages 18-35•Diagnosis of CP•Able to communicate answers to internet based survey

Excluded:•SDR after age 10•History of spinal cord surgery

Subject Characteristics• N = 88– 38 in SDR group, 50 in control group– Average age 27.0 years– Average 22 years after rhizotomy (11.6 - 28.3),

average age at rhizotomy 5 years.– 53.4% female, 44.3% male, 2.3% declined to

answer

Case 5%Control 26%Total 17%

Case 18%Control 36%Total 28%

Case 29%Control 8%Total 17%

Case 37%Control 14%Total 24%

Case 11%Control 16%Total 14%

Pain• Hypothesis: The proportion of subjects reporting pain will be

the same between the SDR group and the controls, but the severity and pain interference will be lower in the SDR group.

• Survey Tools:– PROMIS Pain Intensity - Short Form 3a– PROMIS Pain Interference - Short Form 8a– Pain Location – original questions

Pain - Results• SDR status did not significantly predict pain incidence,

intensity, or interference.– Approximately 70% had experienced pain in the past week.

• Low back and lower extremity pain most common.– Low back pain: 42% overall, 34.2% of cases vs 48.0% of

controls (p = 0.194).– LE pain: 54.5% overall, 52.6% of cases vs 56.0% of controls (p

= 0.753).

Fatigue• Hypothesis: Compared to the control group,

subjects in the SDR group will report lower levels of fatigue.

• Survey Tool: Fatigue Severity Scale– 9 statements, rated on level of agreement

Fatigue – Results• No significant difference in FSS scores

between two groups.

Change in Function• Hypothesis: Compared to the control group,

subjects in the SDR group will be less likely to report decline in motor function.

• Survey Tool: Original questions

Change in Function - Results• SDR group less likely to report a decline in

overall motor function, more likely to report improvement.

• No significant difference when asked specifically about walking ability.

Change in Function – Results

Х2 (2, 86) = 9.131, p = 0.010

Implications• Impact of rhizotomy may be long lasting.– SDR subjects less likely to perceive general motor

decline, though insufficient data to determine if also true for walking ability.

– No significant difference in pain or fatigue.

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