Al-Kharabsheh Yazan E, Said Anas, Ismaiel Ismail A, Khawaja Issam, Altaher Marwan, Bani-Ahmed Ali, Cirstea Carmen M
University of Missouri School of Medicine, Columbia, MO, United States.
Department of Neurosurgery, Al Bashir Hospital, Amman, Jordan.
Front Neurol. 2025 Jan 29;16:1502451. doi: 10.3389/fneur.2025.1502451. eCollection 2025.
Spasticity management in children with cerebral palsy (CP) is a challenge for healthcare providers worldwide. In the US and Europe, treatment options include non-surgical and surgical (i.e., selective dorsal rhizotomy, SDR) procedures, with beneficial effects on functional motility. SDR was introduced in Jordan in 2019. We performed the first assessment of the long-term effects on motor function in Jordanian children with spastic CP (SCP) who underwent SDR.
A retrospective cohort study of 43 patients (28 boys, 15 girls, mean ± SD age at surgery, 6.2 ± 2.5 years, 67.4% with diplegia, 30.2% quadriplegia, and 2.3% hemiplegia, 97.7% bilateral deficits) who received SDR (42 bilateral) was conducted between 01/01/2019 and 03/01/2023. Gross Motor Function Classification System (GMFCS) and Functional Mobility Scale (FMS) scores were compared before and 12 months after SDR. Sex, age and clinical scores at surgery, and post-SDR surgical treatment were included in the model (IBM SPSS Statistics 29.0).
Clinical scores improved 12 months after SDR: GMFCS decreased by at least one level (in 58.5% of patients), and FMS significantly increased ( < 0.001); GMFCS decreased in 77.7% of those with pre-SDR severe impairment vs. 43.5% in moderately to mildly impaired patients. An age sub-analysis demonstrated higher changes in GMFCS in younger children (GMFCS decreased in 46.9% of those aged <10 years old vs. none in those older than 10 years). These findings suggest that younger children (<10 years old) and more impaired (levels IV and V on GMFCS) are likely the best candidates for this procedure. Twelve-month functional improvement was similar in boys and girls (GMFCS decreased in 44.0% of boys vs. 37.5% of girls). Compared to pre-SDR management, all patients continued physiotherapy, less received Botox (by 97.7%), and more received adjunct orthopedic surgeries (32.6% vs. none) after SDR; out of those receiving post-SDR adjuvant surgeries, 50.0% improved GMFCS (compared to 64.0% of those without).
Our data demonstrated SDR's beneficial long-term effects on functional mobility in SCP children, particularly those younger than 10 years and more severely impaired. These findings provide critical information that may aid in identifying "the best" therapeutic window and "the best" candidate for SDR in Jordan.
对全球医疗服务提供者而言，管理脑瘫（CP）患儿的痉挛状态是一项挑战。在美国和欧洲，治疗选择包括非手术和手术（即选择性背根切断术，SDR）程序，对功能运动有有益影响。SDR于2019年引入约旦。我们对约旦痉挛型脑瘫（SCP）患儿接受SDR后的运动功能长期影响进行了首次评估。
对2019年1月1日至2023年3月1日期间接受SDR（42例双侧）的43例患者（28例男孩，15例女孩，手术时平均年龄±标准差为6.2±2.5岁，67.4%为双瘫，30.2%为四肢瘫，2.3%为偏瘫，97.7%为双侧缺陷）进行回顾性队列研究。比较SDR术前和术后12个月的粗大运动功能分类系统（GMFCS）和功能活动量表（FMS）评分。模型中纳入了性别、年龄、手术时的临床评分以及SDR后的手术治疗（IBM SPSS Statistics 29.0）。
SDR术后12个月临床评分改善：GMFCS至少降低一个等级（58.5%的患者），FMS显著提高（<0.001）；SDR术前严重受损患者中77.7%的GMFCS降低，而中度至轻度受损患者中这一比例为43.5%。年龄亚组分析表明，年幼儿童（<10岁）的GMFCS变化更大（<10岁的儿童中46.9%的GMFCS降低，而10岁以上的儿童中无一例降低）。这些发现表明，年幼儿童（<10岁）和受损程度更高（GMFCS为IV级和V级）的儿童可能是该手术的最佳候选者。男孩和女孩术后12个月的功能改善相似（男孩中44.0%的GMFCS降低，女孩中为37.5%）。与SDR术前管理相比，所有患者术后继续接受物理治疗，接受肉毒杆菌毒素治疗的患者减少（减少97.7%），接受辅助骨科手术的患者增多（32.6% vs 术前无）；在接受SDR后辅助手术的患者中，50.0%的患者GMFCS改善（未接受辅助手术的患者中这一比例为64.0%）。
我们的数据表明SDR对SCP患儿功能活动有有益的长期影响，尤其是对10岁以下和受损更严重的患儿。这些发现提供了关键信息，可能有助于确定约旦SDR的“最佳”治疗窗口和“最佳”候选者。
