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
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Long(er) term
Relatively large N
Control group
Unique outcomes
Primary Outcomes
• Pain
• Fatigue
• Change in function
Study Design
• Case control design
• Internet survey
Study Groups
Surgical
Group
SDR
(n = 38)
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
No SDR
(n = 50)
Control
Group
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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