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29 April 2019

Surgery shown to improve walking for children with cerebral palsy

Children with cerebral palsy will now be able to have a surgical procedure that can improve their ability to walk, after analysis by King's and the NIHR Guy’s and St Thomas’ Biomedical Research Centre (BRC) showed it to be effective.


The procedure, known as selective dorsal rhizotomy, involves cutting some of the sensory nerves from the legs as they enter the spinal cord in order to relieve stiffness, improve mobility and reduce children’s pain levels. The operation is irreversible, and it had not previously been fully established whether it helped to improve children’s quality of life, or what the longer term effects were.

Because of the lack of evidence of the benefits of the procedure, NHS England established an innovative study that assessed eligible children with cerebral palsy before and after the operation. Researchers at King’s were commissioned by the National Institute for Health and Care Excellence (NICE) to find out whether selective dorsal rhizotomy did improve outcomes for these children with cerebral palsy.

Cerebral palsy is the name for a group of lifelong conditions that affect movement and co-ordination, caused by abnormal development or damage to the brain that occurs before, during or soon after birth. In the UK around 1,700 children every year are born with cerebral palsy. Treatments include medicines to relieve muscle stiffness, pain relief, and physiotherapy to aid walking.

Janet Peacock, Professor of Medical Statistics at King’s said: “We were commissioned to fill an evidence gap around selective dorsal rhizotomy for treating cerebral palsy – previous trials didn’t look at children’s quality of life and there was not enough evidence about how children fared in the longer term. Those were both important aspects to be considered. Our study provided convincing evidence that the procedure helped the children.

“NHS England have now decided that this procedure will be funded as a direct result of this innovative project. It’s great to get this decision so that it will make a difference to patients.”

Five centres were selected to perform selective dorsal rhizotomy, resulting in 137 children receiving the procedure. The team at the NIHR Guy’s and St Thomas’ BRC and King’s Technology Evaluation Centre (KiTEC) then collected and analysed data on patients’ progress for two years after their operations. Their results, published in The Lancet Child and Adolescent Health, showed the procedure benefitted children by improving their movement, quality of life and levels of pain. They also found that there were no significant health risks to the children from the procedure.

This evidence was strong enough that NHS England has decided to fund the procedure for eligible children aged 3-9  years.

Health Secretary Matt Hancock said: “This is a revolutionary treatment which has the power to transform the lives of young children with cerebral palsy and give fresh hope to their families.

“Every parent dreams of seeing their children live long, healthy and happy lives and I’m absolutely delighted the NHS is funding this new procedure as part of our Long Term Plan."

The full paper is available online.