Efficacy of novel protocol guided single-level laminectomy selective dorsal rhizotomy plus intensive rehabilitation for children with spastic cerebral palsy

Objective To evaluate the efficacy of novel protocol guided single-level laminectomy selective dorsal rhizotomy (SL-SDR) plus intensive rehabilitation for children with spastic cerebral palsy and explore the relevant prognostic factors. Methods A retrospective analysis was conducted for the clinical data of 67 children with spastic cerebral palsy undergoing novel protocol guided SL-SDR plus intensive rehabilitation from September 2015 to October 2016. Analysis was conducted for muscular tone, joint range of movement, muscular strength, gross motor function classification system(GMFCS) grading and gross motor function measure-66(GMFM-66) scores pre, 6 months post and at least 12 months post-operation. Multivariate Logistic regression was employed for identifying the prognostic factors. Results During a mean follow-up period of 12.7 months, downgrading level of GMFCS was one (n=22) and two (n=4). Forty-one cases maintained original grade and there was no upgrading. Downgrading of GMFCS was significantly better in cases with baseline GMFCS Ⅱ/Ⅲ(20/37 vs. 6/23, P=0.034) and cases ≤ 6 years (20/31 vs. 6/29, P=0.001)than those of Ⅳ/Ⅴ and >6 years. Improvement of GMFM-66 was significantly better in cases with baseline GMFCS Ⅰ-Ⅲ (13.4±2.8 vs. 8.7±4.6, P=0) and cases ≤6 years (13.5±3.6 vs. 9.8±3.9, P=0) than those of Ⅳ/Ⅴ and >6 years respectively. Multivariate Logistic regression demonstrated that age (OR: 0.491, 95%CI: 0.324-0.743, P=0.001) and preoperative status of GMFCS (OR: 0.225, 95%CI: 0.086-0.589, P=0.002)were independent factors associated with GMFCS downgrading at 12 months post-operatively. Multivariate Logistic regression analysis revealed that age (OR: 0.575, 95%CI: 0.404-0.820, P=0.002) and preoperative GMFCS (OR: 0.103, 95%CI: 0.031-0.344, P=0) were independent prognostic factors for an improvement of GMFM-66 at least 10 points at 12 months post-operatively. Conclusions Gross motor functions of children with spastic cerebral palsy undergoing novel protocol guided SL-SDR plus intensive rehabilitation improve dramatically at 12 months after the treatment. And more benefits are available for those with baseline GMFCS level Ⅰ-Ⅲ and aged under 6 years. Key words: Child; Spastic cerebral palsy; Surgical therapy; Rehabilitation therapy; Medium-term efficacy