Nonselective Partial Dorsal Rhizotomy: A Clinical Experience with 1-Year Follow-Up

Abstract

The ability to perform a ‘selective’ dorsal rhizotomy has been challenged. EMG responses are inconsistent and often do not represent reflex responses. We perform nonselective partial dorsal rhizotomy (NSPDR) when reflex response is not evident. Ten children undergoing primarily NSPDR were evaluated preoperatively and postoperatively with the Modified Ashworth Scale, gait lab analyses gross motor function measure and the NSPDR was performed by nonselectively sectioning 50–75% of the dorsal roots not demonstrating a reflex response. Standard selective rhizotomy was performed in the remainder. Only 17 of 106 (16%) dorsal roots demonstrated reflex responses. The results reported in this study demonstrate a benefit to patients undergoing primarily NSPDR which is similar to that reported for patients in whom a selective procedure was intended.

Long‐term effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review

“…One study reported that in only 16% of the patients did the relevant rootlets display pathological reflex responses and, as a result, when performing the SDR, 84% of the children underwent a non‐selective procedure . At the 1‐year follow‐up these children displayed outcomes similar to those who had undergone more selective surgery, raising concerns over the ‘selectivity’ of this approach and questioning the belief that selective rhizotomy is more beneficial than the random procedure …”

“…67 At the 1-year follow-up these children displayed outcomes similar to those who had undergone more selective surgery, raising concerns over the 'selectivity' of this approach and questioning the belief that selective rhizotomy is more beneficial than the random procedure. 67 Although complications and adverse events secondary to SDR occur, the prevalence of acute complications has not always been reported. In this review, only a minor portion of the 16 long-term studies reported on complications and side effects.…”

The Evolution of Selective Dorsal Rhizotomy for the Management of Spasticity

“…Questions regarding the usefulness and indeed the need of intraoperative neuromonitoring and the technique of fascicular dissection have been asked many times [41,[45][46][47][48]. On the one side of the argument, Nishida and colleagues [49] wrote that neurophysiological testing may have a significant impact on outcomes of SDR.…”

“…They measure and describe in great detail these electrophysiological reflexes, while Steinbok [46] showed an improvement in function in lower limbs, of about 90%, independent of the emphasis that was placed on neuromonitoring and the fascicular dissection techniques. Warf and colleagues [47] also showed that a SDR technique without fascicular dissection or neurophysiological monitoring can be effective in a resource-scarce environment. Steinbok [50] also showed that SDR without neuromonitoring is equally safe and yields similar results to SDR with the use of neurophysiological mapping.…”

Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria

“…8,20,21,33 Nonselective dorsal rhizotomy, in which some dorsal nerve rootlets (usually about 50%) are divided without neurophysiological investigation, appears to produce similar results. 27 Patient selection is important in maximizing chances for a satisfactory result from SDR. Although the specific criteria for SDR vary by institution, widely adopted guidelines have been published.…”