Cervical cord deformation in cerebral palsy: Structural signatures of gross motor function and outcomes after selective dorsal rhizotomy

AIM: To identify structural signatures of cerebral palsy (CP) motor impairment and selective dorsal rhizotomy (SDR) outcomes using spinal cord deformation-based morphometry (scDBM). METHOD: This retrospective study quantifies spinal cord structural abnormalities in 39 children with CP, stratified by the baseline motor function (Gross Motor Function Classification System [GMFCS] levels I-II, n = 21 and GMFCS level > II, n = 18). T1-weighted clinical images were non-linearly registered to a healthy normative template. Localized spinal cord tissue volume change was modeled against baseline Gross Motor Function Measure (GMFM-66) and 12-month postSDR improvement. RESULTS: In children with ambulatory impairment (GMFCS level > II, n = 18), lower motor capacity correlated with localized rostral cervical (C1-C4) deformation (p < 0.05); no correlates were identified in GMFCS levels I to II (n = 21). Clinical improvement after SDR was associated with baseline C1 dimensions closer to normative adult values, specifically involving reticulospinal and vestibulospinal tracts (p < 0.05). INTERPRETATION: Spinal cord morphology reflects motor potential and surgical outcomes in CP (GMFCS level > II). Localizing C1 structural deficit, scDBM may provide an objective structural signature of severity to identify presurgical candidates with the necessary reserve to translate spasticity reduction into clinically meaningful motor gains.