Selective Dorsal Rhizotomy and Intrathecal Baclofen for Children with Spastic Cerebral Palsy: A Systematic Review

Introduction: Spasticity is a common condition in patients with cerebral palsy, significantly impacting quality of life. Among the most common advanced therapeutic approaches are Selective Dorsal Rhizotomy (SDR) and the Intrathecal Baclofen Pump (ITB).

Methods: We performed a systematic review retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. Articles were screened using the following inclusion criteria: 1) peer-reviewed articles reporting outcomes after SDR and ITB; 2) outcomes reported using a quantifiable scale or standardized outcome measure; 3) patients diagnosed with CP; 4) article and/or abstract in English.

Results: Seven studies met inclusion criteria. Silva et al. and Albright found that both SDR and ITB are effective in reducing spasticity, with no significant differences between treatments in terms of hip dislocation rates and need for subsequent surgeries, and both effectively reducing upper limb spasticity. While Kan et al. highlighted the superiority of SDR in terms of spasticity reduction and improvement in motor function, Mansur's study indicates that ITB may be more suitable for patients with more severe symptoms, despite a higher risk of complications. Van de Pol et al. show the efficacy of SDR in children with hereditary spastic paraplegia, especially those who are ambulant, while ITB was reserved for more severe and progressive cases. Ingale et al. found that functional improvement was greater with SDR. Finally, Niedzwecki et al. note that the length of stay in the rehabilitation unit after SDR is longer, and functional efficiency varies with the type of surgery and clinical characteristics of patients.

Conclusion : Both SDR and ITB are effective in reducing spasticity in patients with CP, with no significant differences in hip dislocation rates or the need for additional surgeries. Procedure selection should be individualized.