Perioperative complications in children undergoing selective posterior rhizotomy: a review of 105 cases

Wiele, Barbara Van de; Staudt, Loretta A.; Rubinstien, Eduardo; Nuwer, M.R.; Peacock, Warwick J.

doi:10.1046/j.1460-9592.1996.d01-21.x

Cited by 10 publications

(10 citation statements)

References 2 publications

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“…In both cases it was readily treated and did not prolong hospitalization. Bronchospasm was noted in 1 patient (0.6%), an incidence similar to that reported by Van de Wiele et al [18]. In contrast, Abbott et al [20] reported much higher rates of these respiratory complications until special precautions were taken.…”

Section: Intraoperative Complicationssupporting

confidence: 73%

“…Urinary tract infections (0.6%) were unusual despite the almost universal use of an indwelling catheter, and were less common in this study than reported elsewhere [18]. Balanitis occurred in 2 male children, in whom the foreskin was not pulled forward after intraoperative catheterization.…”

Section: Perioperative Complicationscontrasting

confidence: 46%

“…In several reports about the results of SDR, various side effects of the operation have been discussed [14][15][16][17][18] but few studies have addressed comprehensively the complications of SDR [12,19,20]. This study details the intraoperative, perioperative (immediate postoperative until discharge at approximately 7 days) and postdischarge complications secondary to SDR in a consecutive series of 158 children.…”

Section: Discussionmentioning

confidence: 99%

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Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Steinbok

Schrag²

1998

Pediatr Neurosurg

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Selective dorsal rhizotomy (SDR) has been shown to be an effective treatment for the spasticity of cerebral palsy, but few studies have addressed specifically the side effects of the procedure. A retrospective study was performed to determine the frequency and nature of complications in 158 children who had undergone SDR at British Columbia’s Children’s Hospital from 1987 to 1996. Intraoperative, preoperative (immediate postoperative until discharge at approximately 7 days) and postdischarge complications occurred in 3.8, 43.6 and 30% of patients, respectively. The most common intraoperative complication was aspiration pneumonia, which was experienced by 2 patients (1.3%). Perioperatively, sensory changes were found in 8.9% of the children, and transient urinary retention in 4.4%. Complications after discharge included back pain starting more than 6 months after surgery in 10.8%, sensory changes in 13.9%, and neurogenic bladder or bowel problems in 12.7%. Persistent sensory changes occurred in 3.8%, were not important functionally, and tended to occur in patients with the largest amount of dorsal root tissue cut. In 8 patients (5.1%), bladder and/or bowel dysfunction attributed to the SDR was present at the latest follow-up, although in only 2 patients (1.3%) this dysfunction was a definite complication of the rhizotomy. The use of pudendal monitoring and/or cutting less than 50% of the S2 roots may have been associated with a lower incidence of long-term sphincter dysfunction. Data about the nature and frequency of complications may result in further modifications to the SDR procedure, and is critical for counseling about SDR and alternative options available for treatment of the child with spastic cerebral palsy.

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Section: Intraoperative Complicationssupporting

confidence: 73%

Section: Perioperative Complicationscontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Steinbok

Schrag²

1998

Pediatr Neurosurg

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“…In comparison, no significant complications were noted in a series of 105 cases [61]. Sensory loss and transient hyperesthesias are often seen after selective posterior rhizotomy, but can be minimized when the percentage of nerve rootlets sectioned is kept to a minimum.…”

Section: Complications Of Rhizotomymentioning

confidence: 99%

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

et al. 2001

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Spasticity occurs in children and adults due to a wide range of conditions, including cerebral palsy, head and spinal cord trauma, cerebrovascular accidents and multiple sclerosis. Multiple treatment options have been described, including medical and surgical treatments. Medical treatments include intramuscular botulinum A toxin, oral baclofen and supportive bracing. Surgical approaches include selective posterior rhizotomy, intrathecal baclofen and orthopedic procedures to address deformities. Many reports have been published on these different treatment options, but rarely has a comparison been made between them. Therefore, this review is aimed at comparing selective posterior rhizotomy and intrathecal baclofen injection for spasticity due to cerebral palsy, especially in children.

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“…In our study, we found that between 487 and 542 operations are performed per year by the 36 centers included. Van de Wiele et al [23 ]treated 105 children suffering from spasticity with SDR between 1986 and 1991. Park [2] operated 681 patients with spastic diplegia and quadriplegia between 1989 and 1999.…”

Section: Discussionmentioning

confidence: 99%

Selective Dorsal Rhizotomy and Postoperative Pain Management

Hesselgard¹,

Reinstrup

Strömblad³

et al. 2007

Pediatr Neurosurg

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Background: Selective dorsal rhizotomy (SDR) is an operation method that decreases the degree of spasticity with long-lasting beneficial effects for children with spastic diplegia. Children undergoing SDR are postoperatively in severe pain, a pain related to both the extensive surgical exposure with multilevel laminectomy and the nerve root manipulation. Various pain management strategies for children undergoing SDR have been published. The postoperative pain treatment is a vital part of the management. The aim of this study was to estimate the number of centers performing SDR, the frequency of SDR surgery and to investigate pain management of the different centers. Methods: A questionnaire comprising 7 questions was sent by mail and/or e-mail to a total of 59 potential centers performing SDR, centers that have published material concerning SDR or centers that have been recommended. Forty-seven (80%) centers responded to the questionnaire; 11 of them do not presently perform SDR surgery, and the remaining 36 centers constitute the material of the present study. Results: 23 of the 36 centers use Peacock’s operation technique and 8 centers use Park’s technique. Continuous intravenous infusion of opioids for postoperative pain treatment is used by 17 (47%) of the centers. Seven (19%) centers use the epidural (ED) approach for treating postoperative pain and 6 (17%) centers use intrathecal (IT) pain treatment. The duration of intravenous ED or IT pain relief ranged from 24 h up to 7 days. To evaluate pain relief, 25 (70%) centers used some form of pain scale. Conclusion: The most common operation techniques in use today are described by Peacock or by Park, with an estimated number of procedures of more than 487/year in 36 centers. The majority of the centers seem to have a satisfactory pain management strategy. These centers administer continuous infusions of opioids, with an intravenous, ED or IT approach, and incorporate the use of a pain assessment tool to evaluate pain relief.

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Perioperative complications in children undergoing selective posterior rhizotomy: a review of 105 cases

Cited by 10 publications

References 2 publications

Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy

Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity

Selective Dorsal Rhizotomy and Postoperative Pain Management

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