Comparison of efficacy between dorsal root entry zone lesioning and selective dorsal rhizotomy for spasticity of cerebral origin

Sitthinamsuwan, Bunpot; Phonwijit, Luckchai; Khampalikit, Inthira; Nitising, Akkapong; Nunta-aree, Sarun; Suksompong, Sirilak

doi:10.1007/s00701-017-3322-x

Cited by 14 publications

(8 citation statements)

References 37 publications

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“…No change in tone post-SDR was reported in 24.6% (n = 35). Six of 12 publications documented changes in spasticity using the modified Ashworth score (MAS) [8][9][10][11][12][13]. Analysis of adult patients in these publications showed that SDR led to marked reduction in the spasticity of the hip flexors, hip adductors, hamstrings, quadriceps, and gastrocnemius/soleus muscles (Table 3).…”

Section: Efficacy Of Sdr On Managing Spasticity/tonementioning

confidence: 99%

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Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

Kakodkar

Fallah

2021

Childs Nerv Syst

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Purpose Selective dorsal rhizotomy (SDR) has been used to improve mobility and reduce lower extremity spasticity in patients with a various CNS conditions. Incidentally, literature on SDR has been performed in the pediatric population as such there is a paucity of research on the use in adult patients. Methods Studies describing SDR in adults were identified from Medline and Embase databases. Combinations of search terms "Selective Dorsal Rhizotomy," "Selective Posterior Rhizotomy," and "Adult" were used. Only literature in English language on patients over the age of 18 years and that included measures for lower extremity outcome (i.e., spasticity, mobility) were included. Case reports, reviews without primary data, or inaccessible publications were excluded. Results One hundred twenty-nine publications between 1970 and 2019 were identified. Twelve of these publications fit the inclusion criteria (n = 141 patients). In series where it was reported, SDR resulted in ambulatory improvement (54%, n = 44 out of 81), reduced spasticity (75.2%, n = 106 out of 141), and minimized muscle and joint pain (74.5%, n = 64 out of 86). SDR also showed improvement in parameters of the activities of daily life. 92.3% (n = 48 out of 52) of patients post-SDR developed new lower limb paresthesia. Conclusion The success and efficacy appear durable in the short-term, but further follow-up is necessary to validate these findings. The goal of the intervention dictates the ideal adult patient for SDR. Patients seeking ambulatory improvement, any etiology of spasticity besides MS, seem favorable. Positive locomotive predictors include the ability to isolate lower extremity function, lack of contractures, lower limb strength, and post-SDR physiotherapy.

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Section: Efficacy Of Sdr On Managing Spasticity/tonementioning

confidence: 99%

“…Five publications documented perioperative complications post-SDR (n = 35) [8,11,14,17,18]. Back pain post-SDR was documented in 37.1% (n = 13) of patients.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

Kakodkar

Fallah

2021

Childs Nerv Syst

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“…Dorsal root entry zone lesioning (DREZL) using microsurgical techniques was pioneered by Sitthinamsuwan since the 1970s [49].…”

Section: Technical Advancementsmentioning

confidence: 99%

“…Sitthinamsuwan et al [49] compared the outcomes of patients who underwent SDR for lesions in the dorsal root entry zone with the goal of reducing spasms. They used the modified Ashworth Scale and the Adductor Tone Rating Scale to assess the severity of the spasticity.…”

Section: Technical Advancementsmentioning

confidence: 99%

The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR)

Sun

Huang

Deng

et al. 2020

Brain Science Advances

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Spasticity is the main disabling clinical manifestation of children with cerebral palsy (CP). Selective dorsal rhizotomy (SDR) has been performed for the treatment of spastic CP in Asia for quite some time from 1990. The purpose of this review is to discuss the historical origin and development of SDR. Our goal here is to identify the current patient selection criteria for SDR and to point out indications and contraindications based on the patients with CP, age from 2 to 18 years-old, over 6000 cases, who received SDR surgery with spasticity of muscle tension more than 3 degrees in our center. We also discuss evidence-based approaches on how to evaluate postoperative patient outcomes of SDR and how complications can be avoided. Finally, we mention progress made in terms of SDR technical advances and how improvements can be made in the future. In conclusion, SDR surgery is a reliable way to improve outcomes of patients with spastic CP and can be done carefully in patients as long as stringent selection criteria are used. However, more research and technological advancements are needed to help address associated complications.

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“…This study showed that MDT has the potential to significantly improve the quality of life of the patients. In 2017, Sitthinamsuwan et al 25 Published a study comparing DREZ lesioning and selective dorsal rhizotomy in fifteen spasticity patients. They concluded that DREZ lesioning is more effective to reduce spasticity, but more destructive than selective dorsal rhizotomy.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Dorsal Root Entry Zone Lesioning: Systematic Review

Galafassi

Aguiar

Takahashi

et al. 2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Introduction Dorsal root entry zone (DREZ) leasioning (DREZ-otomy) is considered an effective treatment for chronic pain due to spinal cord injuries, brachial and lumbosacral plexus injuries, postherpetic neuralgia, spasticity, and other conditions. The objective of the technique is to cause a selective destruction of the afferent pain fibers located in the dorsal region of the spinal cord. Objective To identify and review the effectiveness and the main aspects related to DREZ-otomy, as well as the etiologies that can be treated with it. Methods The PubMed, MEDLINE and LILACS databases were used as bases for this systematic review, having the impact factor as the selection criteria. The 23 selected publications, totalizing 1,099 patients, were organized in a table for systematic analysis. Results Satisfactory pain control was observed in 70.1% of the cases, with the best results being found in patients with brachial/lumbosacral plexus injury (70.8%) and the worst, in patients with trigeminal pain (40% to 67%). Discussion Most of the published articles observed excellent results in the control of chronic pain, especially in cases of plexus injuries. Complications are rare, and can be minimized with the use of new technologies for intraoperative monitoring and imaging. Conclusion DREZ-otomy can be considered a great alternative for the treatment of chronic pain, especially in patients who do not tolerate the side effects of the medications used in the clinical management or have refractory pain.

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Comparison of efficacy between dorsal root entry zone lesioning and selective dorsal rhizotomy for spasticity of cerebral origin

Cited by 14 publications

References 37 publications

Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

Systematic review on use and efficacy of selective dorsal rhizotomy (SDR) for the management of spasticity in non-pediatric patients

The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR)

Dorsal Root Entry Zone Lesioning: Systematic Review

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