1451. Meta-Analysis of Spinal Deformities Following Selective Dorsal Rhizotomy

Authors: Paige Selvey; Matthew Wheelwright, PhD; Paul Steinbok; Ash Singhal; George Ibrahim; Aria Fallah; Alexander Weil; Kyle Halvorson; Albert Tu, MD (Eagle Bend, MN)

Introduction: Cerebral palsy is a common neurological disorder that involves spasticity of the extremities and that can lead to lifelong disability. Selective dorsal rhizotomy (SDR) can improve spasticity and quality of life in these patients, but may be associated with development of spinal deformity. Risk factors for spinal deformity after SDR have not been systematically examined. Methods: Medline, Embase, and Web of Science databases were queried for clinical studies reporting incidence of new or worsening spinal deformity after SDR. Variables that represent possible risk factors for deformity were correlated with reported incidence of deformity. Type of deformity (scoliosis, kyphosis, lordosis, spondylolysis/ spondylolisthesis) was also correlated with risk factors. Results: 22 articles were found that met the criteria for inclusion in this study. There exists substantial variation in the incidence of deformity between studies, limiting our analysis. Significant positive correlation was found between the percent of patients that developed scoliosis and percent of patients that were female. Significantly more deformity developed when multilevel laminectomies were extended to S1 versus L5. We found strong trends towards correlation between the incidence of deformity and preoperative GMFCS, number of vertebral levels removed and number of years to follow-up. Conclusion: Spinal deformity is an important potential complication of SDR. Risk factors for postoperative deformity may include female sex, preoperative GMFCS score, and number of vertebral levels affected during the surgery. Deformity appears to increase with extended follow-up, indicating a slow process that should be carefully watched in the longer term.