Surgeons in blue gowns and wearing loupes perform surgery.

New CP Research Network Publication on Selective Dorsal Rhizotomy (SDR)

A neurosurgeon with a full beard, glasses, brown hair and eyes grins in a white lab coast for El Paso Children's Hospital

Dr. Ziyad Makoshi, first author of this publication, completed his neurosurgical fellowship while working with CP Research Network Dr. Jeffrey Leonard at Nationwide Children’s Hospital.

The Cerebral Palsy (CP) Research Network congratulates investigator Ziyad Makoshi, MD and his co-authors[*], for the publication of his CP Research Network manuscript entitled “A Mixed-Methods Study of Practice Variation in Selective Dorsal Rhizotomy: A Study by the Cerebral Palsy Research Network.” The publication, released online in the journal Pediatric Neurology in September 2023, investigates provider perception about SDR candidates against the characteristics of those undergoing SDR in the CP Research Network clinical registry.

Selective dorsal rhizotomy (SDR) is an established procedure for the treatment of spasticity associated with cerebral palsy (CP). There is variation in the patient characteristics, e.g., age, motor function, and co-morbidities, deemed most suitable for the surgery. With the indications (valid reasons for using the procedure) expanding, and sometimes conflicting research results, the study team aimed to investigate provider perceptions about SDR candidates through structured interviews compared with the quantitative results of characteristics of those individuals undergoing SDR in the CP Research Network registry.

The results of the study indicate that most CP Research Network registry participants who receive SDR are 8-12 years and typically function at Gross Motor Functional Classification Level (GMFCS) level II or III while a third of individuals receiving SDR are non-ambulatory (not able to walk, i.e., GMFCS Levels IV and V). When surveyed, providers across the range of clinical disciplines that refer children SDR, varied on what the youngest age for SDR should be but agreed on the most likely GMFCS level for SDR and dystonia screening methods. There was not good agreement providers on whether individuals with CP and dystonia should receive an SDR.

The decision to pursue SDR surgery should be made as a team that includes the caregiver and the individual with CP (whenever possible). With differences in the approach to determining the best candidates for SDR and the differences in technique, age and patient characteristics, discussions with families should acknowledge these variations and allow families to reach a decision based on individual concerns, caregiver and/or patient goals, and expectations of outcomes.

Both the registry and the qualitative study of SDR were inspired by our co-founder’s experience with recommendations for his son with CP. Either an extensive orthopedic intervention or an SDR were recommended for improvement of his gait in 2012. Comparative evidence was lacking and most studies of SDR had been done with strict inclusion criteria about patient characteristics. The registry and the qualitative studies were developed by CP Research Network CEO Gross as building blocks to a much larger observational study of SDR for which the network is currently seeking funding. This mixed method analysis provided important preliminary data for that grant application to the National Institute of Neurological Disorders and Stroke earlier this year. The study team expects to get a funding decision for that study in Q1 2024.

The full journal article is available for free download for the next 45 days in Pediatric Neurology. After December 16, 2023, only subscribers to Pediatric Neurology will have access.

*Jeffrey Raskin, MD, Robert Bollo, MD, Brandon Rocque, MD, Susan Zickmund, PhD, Patrick Galyean, BS, Grace Perry, BA, Samuel Browd, MD, Paul Gross, BA, Kristie Bjornson, PT, PhD and Jeffrey Leonard, MD