Selective dorsal rhizotomy, a surgery in which some sensory nerves from the legs are cut as they enter the spinal cord, has been shown to improve mobility and reduce pain in children with cerebral palsy, according to a study commissioned by the U.K.’s National Institute for Health and Care Excellence (NICE).
Supported by the study’s positive results, the surgery — which is irreversible — is now available to children with cerebral palsy in England through the public National Health Service (NHS).
“Our study provided convincing evidence that the procedure helped the children. NHS England have now decided that this procedure will be funded as a direct result of this innovative project,” Janet Peacock, PhD, researcher and professor at NIHR Guy’s and St Thomas’ Biomedical Research Centre (BRC) and King’s College London, and one of the study authors, said in a press release.
“It’s great to get this decision so that it will make a difference to patients,” she added.
The study results were published in the journal The Lancet, Child & Adolescent Health, in a study titled “Selective dorsal rhizotomy in ambulant children with cerebral palsy: an observational cohort study.”
Because it involves cutting nerves, the procedure is irreversible, Peacock said. She said there was little evidence showing how children who had the surgery fared in the longer term.
To evaluate the long-term effects of selective dorsal rhizotomy, the researchers analyzed clinical data from a total 137 children, ages 3 to 9 and diagnosed with cerebral palsy, who underwent the surgery in five different neurosurgery centers, followed by intense physiotherapy. Participants were all able to walk, either with or without assistance. They were then followed for 2 years and their overall outcomes were evaluated.
Researchers assessed changes from before, and two years after the surgery, as determined by scores on the Gross Motor Function Measure (GMFM-66). Changes in patients’ quality of life also were evaluated based on the Cerebral Palsy Quality of Life Questionnaire. In particular, investigators examined the children’s social well-being and acceptance, feelings about functioning, participation and physical health, emotional well-being and self-esteem, access to services, family health, and pain and impact of disability.
Analyses showed that rhizotomy surgery improved children’s motor function, with mean GMFM-66 scores increasing annually by 3.2 points after surgery.
Improvements were also reported over time in five of the seven quality of life parameters analyzed. These included mean annual improvements of 3.0 units in feelings about functioning, 3.9 units in participation and physical health, and 1.3 units in emotional well-being and self-esteem. Researchers also found a change of 2.0 units in family health, and a reduction of 2.5 units in pain and impact of disability.
“This study shows objectively that the procedure does improve motor function, and doesn’t have dangerous side effects,” said Chris Verity, MD, a consultant pediatric neurologist at Addenbrookes Hospital, who chaired the steering committee that oversaw the study. “For some children with cerebral palsy and their families this could really improve quality of life and help children walk more easily and without the use of walking frames and other aids.”
There were 17 reported adverse events in 15 children during the study, none of which were considered severe; 15 were resolved. The most common adverse events were wound infection and persisting reduced sensation in the feet and legs.
“This is a revolutionary treatment which has the power to transform the lives of young children with cerebral palsy and give fresh hope to their families,” said Matt Hancock, secretary of state for health and social care. “Every parent dreams of seeing their children live long, healthy and happy lives and I’m absolutely delighted the NHS is funding this new procedure as part of our Long Term Plan.”
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