LAUSR

Dear Editor: We read with great interest the article byWheelwright M et al. [1] in which the authors presented an interesting systematic review of spinal deformities following selective dorsal rhizotomy (SDR). This work led us to a retrospective analysis of our series of patients undergone to SDR, evaluating the shortand medium-term incidence of scoliosis, as well as the impact on trunk and head control. Randomized clinical trials have established that SDR reduces lower extremity spasticity, increases lower limb range of motion, and improves functional outcome and quality of life in children with spastic cerebral palsy [2, 3]. Suprasegmental effects following SDR, specifically on upper-extremity function, have been also reported [4]. However, there is no data on the effect on the trunk and neck muscle tone, except for a possible long-term risk of spinal deformity, mostly in female children with severe neurologic impairment and/or pre-existing spinal deformity [1]. The present study aims to evaluate the short and medium-term risk of development of scoliosis and to preliminary assess the global improvement in neck and trunk tone after SDR. This is a retrospective review of a prospective database of patients who underwent SDR at Gaslini Children Hospital between March 2016 and December 2019. A minimally invasive approach to SDR has been chosen, with intraoperatory clinic and neurophysiologyguided partial section of the sensory nerve roots. All patients performed pre-surgery spine x-ray, in order to exclude spinal malformations. Trunk and head control was assessed, using level sitting scale (LSS) [4], before surgery (T0) and then at subsequent follow-up (T1–3 months, T2–6 months, T3–12 months). The LSS is an eight-level validated sitting classification index that provides discrete, measurable descriptions of different sitting abilities [5]. Forty-four pediatric patients (28 male, 63.6%) underwent SDR at our center during the period included in the retrospective study. Median age at SDR was 5.3 years (IQR 3.9–6.7 years). Seven were excluded due to insufficient follow-up data; the remaining 37 children were included in the study. Patients were followed for a median of 12.0months (IQR 7.8– 20.0 months). Five patients (13.5%) were classified as II class GMFCS during pre-surgery evaluation, 13 patients (35.1%) class III, 17 patients (45.9%) class IV, and 2 (5.4%) class V. Mean T0 LSSwas 5.39 ± 1.57, at T1was 5.83 ± 1.48, at T2 was 6.04 ± 1.22, at and at T3 was 6.10 ± 1.16. We observe a significant increase in LSS values from t0 to t1 from t0 to t2 from t0 to t3 and from t0 to the last follow-up (paired sample t test) (Table 1). At T2 48.1% (13/27) of patients had at least one point of improvement in LSS scale and 60% of patients (12/20) at T3. Not surprisingly, the percentage of improvement at T1 was less evident, with an 38.9 % of cases had increasing of score (14/36). Overall, of the 35 patients who did not already have the maximum score on the LSS scale at the pre-surgery evaluation, more than half (54.3%) had an improvement in the LSS at the last follow-up. None of the patients presented a significant worsening at the spine X-ray performed within 12 months of surgery. * Marta Bertamino [email protected]