In nonambulatory children with predominantly spastic cerebral palsy (CP), the authors compared care needs, symptom burden, and complications after surgical treatment with either intrathecal baclofen (ITB) pump insertion or selective dorsal rhizotomy (SDR). The patients were treated at two Canadian centers with variability in practice pertaining to these surgical options.

The authors performed a retrospective analysis of nonambulatory children with predominantly spastic quadriplegic or diplegic CP who underwent treatment with ITB or SDR. These two strategies were retrospectively assessed by comparing patient data from the two treatment groups for demographic characteristics, outcomes, and complications. A partial least-squares analysis was performed to identify patient phenotypes associated with outcomes.

Thirty patients who underwent ITB and 30 patients who underwent SDR were included for analysis. Patients in the ITB group were older and had lower baseline functional status, with greater burdens of spasticity, dystonia, pain, deformity, bladder dysfunction, and epilepsy than patients in the SDR group. In addition, children who underwent SDR had lower Gross Motor Function Classification System (GMFCS) levels and were less likely to experience complications than those who underwent ITB. However, children treated with SDR had fewer improvements in pain than children treated with ITB. A single significant latent variable explaining 88% of the variance in the data was identified.

Considerable baseline differences exist within this pediatric CP patient population. Factors specific to individual children must be taken into account when determining whether ITB or SDR is the appropriate treatment.

在以痉挛性脑瘫 (CP) 为主的非卧床儿童中，作者比较了鞘内巴氯芬 (ITB) 泵插入或选择性脊神经根切断术 (SDR) 手术治疗后的护理需求、症状负担和并发症。这些患者在加拿大的两个中心接受治疗，这些中心在与这些手术选择相关的实践中存在差异。

作者对接受 ITB 或 SDR 治疗的主要为痉挛性四肢瘫痪或双瘫 CP 的非卧床儿童进行了回顾性分析。通过比较两个治疗组的人口统计学特征、结果和并发症的患者数据，对这两种策略进行了回顾性评估。进行偏最小二乘法分析以确定与结果相关的患者表型。

30 名接受 ITB 的患者和 30 名接受 SDR 的患者被纳入分析。与 SDR 组患者相比，ITB 组患者年龄较大，基线功能状态较低，痉挛、肌张力障碍、疼痛、畸形、膀胱功能障碍和癫痫的负担更大。此外，与接受 ITB 治疗的儿童相比，接受 SDR 治疗的儿童的粗大运动功能分类系统 (GMFCS) 水平较低，发生并发症的可能性也较小。然而，与接受 ITB 治疗的儿童相比，接受 SDR 治疗的儿童在疼痛方面的改善较少。确定了解释数据中 88% 方差的单个显着潜在变量。

在这个儿科 CP 患者群体中存在相当大的基线差异。在确定 ITB 或 SDR 是合适的治疗方法时，必须考虑个别儿童的具体因素。