Individual research recommendation details

Recommendation ID

CG145/5

Question

Selective dorsal rhizotomy:- Does selective dorsal rhizotomy followed by intensive rehabilitation performed between the ages of 3 and 9 years in children who are at Gross Motor Function Classification System (GMFCS) level II or III result in good community mobility as a young adult?

Any explanatory notes
(if applicable)

Why this is important:- The available evidence relating to selective dorsal rhizotomy suggests that the procedure results in some short- and medium-term improvements in motor function. The effects reported were not consistent across all studies nor sustained across all durations of follow-up investigated (6–24 months). The Guideline Development Group (GDG) considered that if the observed improvements could be maintained through to adult life then the outcomes of selective dorsal rhizotomy would be clinically important. Further research is urgently needed to evaluate long-term outcomes (including adverse effects) of selective dorsal rhizotomy followed by an intensive rehabilitation programme involving physical therapy (and prioritising targeted strength training) compared with physical therapy alone. The research could be conducted using a range of designs, including randomised controlled trials and audits of outcomes from procedures already performed. The research should focus on selective dorsal rhizotomy performed between the ages of 3 and 9 years in children who are at Gross Motor Function Classification System (GMFCS) level II or III (because these children are likely to benefit most from selective dorsal rhizotomy) and before the development of significant contractures at the ankles, knees and hips. The research should be coordinated through a multicentre research programme; use nationally agreed outcome measures (such as incidence of neurological impairment and spinal deformity, the need for additional operations, and assessment of disability, social inclusion and quality of life) and follow-up periods to facilitate national audit; and include assessment of the child's clinical condition before and after selective dorsal rhizotomy using the same formally validated assessment techniques. The full guideline includes further considerations relating to criteria for identifying children who could be included in the research, the timing of selective dorsal rhizotomy in relation to other treatments such as orthopaedic surgery, and information that should be given to children and their parents or carers to facilitate informed decision making about participation in research.

Source guidance details

Comes from guidance

Spasticity in under 19s: management

Number

CG145

Date issued

July 2012

Other details