Long-term multidimensional outcomes following selective dorsal rhizotomy in children with cerebral palsy: a prospective single-center study

OBJECTIVE: The aim of this study was to evaluate the influence of age group (3-9 vs 10-18 years), sex, Gross Motor Function Classification System (GMFCS) level, and presence of dystonia on changes in multidimensional functional test outcomes at 24 months, along with extended assessment of long-term effects at 5 and 10 years, following selective dorsal rhizotomy (SDR). METHODS: This is a prospective single-center observational study of all children aged 3-18 years with functionally significant bilateral spastic cerebral palsy who underwent SDR at a tertiary pediatric neurosurgery center between 2012 and 2025. Outcome evaluation followed a tiered, multimodal framework, and each domain was evaluated before SDR and at each follow-up assessment 3, 6, and 12 months and 2, 5, and 10 years after SDR if follow-up data were available. A linear mixed-effects model was used to assess longitudinal changes. RESULTS: Between 2012 and 2025, 420 children who satisfied the study inclusion criteria underwent SDR. The mean age was 7.02 ± 3.02 years, and 62% of the patients were male. The most frequent GMFCS level before surgery was III. At 24 months after SDR, the 66-item Gross Motor Function Measure scores had improved significantly (mean difference 4.3 units, 95% CI 3.1-5.6, p < 0.001). Statistically significant improvements were also observed on the Timed Up and Go test, Pediatric Evaluation of Disability Inventory (PEDI) of self-care and mobility, 6-minute walk test distance, Functional Mobility Scale, Gillette Functional Assessment Questionnaire, and PEDI Computer Adaptive Test. Pain scores and Care and Comfort Hypertonicity Questionnaire scores decreased, whereas quality of life measures (Cerebral Palsy Quality of Life Questionnaire for Children, CPCHILD Questionnaire) showed marked gains by the extended follow-up. CONCLUSIONS: SDR can lead to improvements in gross motor performance, quality of life, and overall functional outcomes at 24 months postoperatively. Future prospective multicenter studies incorporating a control group are required to investigate the effect and safety of SDR.