Outcomes of single-level vs multiple-level selective dorsal rhizotomy for children with spastic cerebral palsy

This study aimed to investigate the effect of single-level selective dorsal rhizotomy (SL-SDR) and multiple-level selective dorsal rhizotomy (ML-SDR) for children with spastic cerebral palsy (SCP). Data of SCP children undergoing SDR from July 2020 to January 2023 were collected and divided into SL-SDR and ML-SDR groups. Assessments at baseline and one-year follow-up included modified Ashworth scale (MAS), gross motor function measure-66 (GMFM-66), and activities of daily living (ADL). Early postoperative evaluations included average daily ibuprofen frequency (ADIF) and additional analgesic usage in the first week, ambulating-intolerance rates at the first-week end, and complications at the three-month follow-up. A total of 134 patients (66 boys, 49.3%; 68 girls, 50.7%) were included, with 61 (45.5%) undergoing SL-SDR and 73 (54.5%) undergoing ML-SDR. All patients showed significant improvements in MAS, GMFM-66 and ADL scores at one-year follow-up compared to baseline (P < 0.05), but no significant difference was found between the two groups at baseline or at one-year follow-up. Postoperatively, all patients received 24-h analgesic-pump treatment, and significant differences were noted between the two groups in ADIF, additional analgesic usage during the first week and ambulating-intolerance rates at the first-week end (P < 0.05). Poor wound healing occurred more frequently in ML-SDR group (P < 0.05). Both SL-SDR and ML-SDR effectively reduce spasticity, improve motor function, and enhance daily activities in SCP children. However, SL-SDR is associated with less tissue damage, reduced pain, a lower incidence of wound healing issues, and better tolerance to postoperative rehabilitation, with an earlier recovery timeline.