Journal CME September 2026: Potential predictors of hip surgery following selective dorsal rhizotomy in children with cerebral palsy: Survival analysis of a retrospective cohort-PM R - 2026 - Krajewski - Potential predictors of hip surgery following selective dorsal rhizotomy in children with

PM R - 2026 - Krajewski - Potential predictors of hip surgery following selective dorsal rhizotomy in children with

Pdf Summary

This retrospective cohort study examined children with cerebral palsy who underwent selective dorsal rhizotomy (SDR) to identify factors predicting later hip surgery. Among 68 patients (135 hips), 16 patients required hip surgery about 3 years after SDR, and most procedures were bony reconstructions.<br /><br />The main finding was that a higher preoperative acetabular index (AI) strongly predicted the need for hip surgery after SDR, even after adjusting for age and sex. In the final Cox survival model, AI remained the only significant predictor; migration index and Gross Motor Function Classification Scale (GMFCS) level were significant in simpler analyses but not in the adjusted model. Age at SDR, gender, rootlets cut, and neck-shaft angle were not significant predictors.<br /><br />Receiver operating characteristic analysis suggested an AI cutoff of 23° for the full sample, with 63.3% sensitivity and 80.0% specificity. When stratified, the cutoff was 23° for males and 25° for females; when grouped by GMFCS, the cutoff was 21° for GMFCS I/II and 23° for GMFCS III/IV/V.<br /><br />Clinically, children with an AI of 23° or greater at the time of SDR were more likely to need hip surgery later, and if surgery was avoided initially, those with lower AI tended to remain surgery-free for much longer. The authors conclude that AI may be more useful than GMFCS level or migration index for counseling families about future hip surgery risk when considering SDR.

Keywords

cerebral palsy

selective dorsal rhizotomy

hip surgery

acetabular index

predictive factors

retrospective cohort study

gross motor function classification scale

migration index

receiver operating characteristic

pediatric orthopedics