Selective Dorsal Rhizotomy

Abbott, Rick; Johann-Murphy, Marjorie; Shiminski-Maher, Tania; Quartermain, David; Forem, Sandra L.; Gold, Joan; Epstein, Fred J.

doi:10.1097/00006123-199311000-00010

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…These complications include, but not are limited to, transient dysesthesias, numbness, tingling, transient urinary retention (frequent), back pain, headache, infections, pneumonia, bronchospasm, ileus, hemorrhage, cerebrospinal fluid leak from the surgical side, meningitis, fluid collection or seroma beneath the skin, incomplete reduction of the spasticity, muscle weakness, spinal deformities (scoliosis, kyphosis, hyperlordisis, spondylolisthesis), permanent hypoesthesia (rare), permanent urinary incontinence (rare), impotence, bladder and bowel dysfunction, spinal cord stenosis, risks associated with general and local anesthesia (rare), and the risk of death (extremely rare). [ 10 23 29 47 48 49 ] We have not encountered any intraoperative or postoperative complications in our patients, and they were all doing well at their subsequent follow-up assessments.…”

Section: Discussionmentioning

confidence: 74%

“…Farmer et al ., at the Montreal Children's Hospital and the Shriners Hospital for Children had most rigorously evaluated the benefit and the short-term and long-term outcomes of this procedure and documented significant positive findings from several functional perspectives. [ 4 9 21 22 23 24 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 9 34 35 36 37 38 ] Reduction of spasticity is what patients and their families expect as a means to an end, and many studies have documented that, but that does not guarantee functional improvement. [ 23 34 35 ] After the surgery, patients have increased strength and range of motion in their affected limbs, which helps them in their daily activities. [ 34 38 39 40 41 ] Patients who can ambulate without assistance had more benefit from SDR compared to patients who could ambulate with assistance or could not ambulate before the procedure.…”

Section: Discussionmentioning

confidence: 99%

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Selective dorsal rhizotomy: A multidisciplinary approach to treating spastic diplegia

et al. 2017

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Background:Spasticity is a motor disorder that interferes with mobility and affects the quality of life. Different approaches have been utilized to address patients with spastic diplegia, among which is selective dorsal rhizotomy (SDR). Although SDR has been shown to be efficacious in treating spastic patients, many neurologists and neurosurgeons are not well aware of the procedure, its indications, and expected outcomes due to the limited number of centers performing this procedure.Objectives:The aim of this study is to describe the collaborative multidisciplinary approach between neurosurgeons, neurophysiologists, and physiotherapists in performing SDR. In addition, we delineate three illustrative cases in which SDR was performed in our patients.Materials and Methods:A retrospective review and analysis of the clinical records of our three patients who underwent SDR was conducted and reported. Patients’ outcomes were evaluated and compared to preoperative measurements based on clinical examination of power, tone (Ashworth scale), gait, and range of motion, as well as subjective functional assessment, gross motor function classification system, and gross motor function measure with follow-up at 6, 12, and 24 months postoperatively. A detailed description of our neurosurgical technique in performing SDR in collaboration with neurophysiology and physiotherapy monitoring is provided.Results:The three patients who underwent SDR using our multidisciplinary approach improved both functionally and objectively after the procedure. No intraoperative or postoperative complications were encountered. All patients were doing well over a long postoperative follow-up period.Conclusion:A multidisciplinary approach to treating spastic diplegia with SDR can provide good short-term and long-term outcomes in select patients suffering from spastic diplegia.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Selective dorsal rhizotomy: A multidisciplinary approach to treating spastic diplegia

et al. 2017

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“…Earlier studies by Abbott et al . [ 26 ] and Steinbok and Schrag[ 27 ] report higher complication rates, of 17.5% and 43.6%, respectively; however, these data might reflect further refinements of the surgical technique, since these patients were all operated on before 2003. We have not experienced any other complications such as urinary retention, orthostatic headache, nausea / vomiting, and urine or chest infections, but these might rarely occur.…”

Section: Discussionmentioning

confidence: 99%

Surgical results of selective dorsal rhizotomy for the treatment of spastic cerebral palsy

et al. 2021

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A BSTRACT Background: Selective dorsal rhizotomy (SDR) is one of the surgical alternatives for treating spasticity, especially in children with spastic diplegia secondary to cerebral palsy (CP). It is becoming increasingly used, and the results of this operation need to be further highlighted. Aim: The main objective of this article was to present the results of such surgical procedure in a cohort of a specialized center, with a particular focus on a quantitative analysis (goniometry). Materials and Methods: Retrospective review of the medical records and gait analyses of a cohort of 34 patients diagnosed with CP submitted to elective SDR at our institution, in a period of 6 years, was carried out. All patients underwent a thorough clinical and neurological assessment, gait analysis at a dedicated laboratory, and magnetic resonance imaging of whole neuro-axis. Statistical Analysis: For continuous quantitative variables (goniometric angles and muscle tone), a t -student test was used. A scatterplot regression analysis was used for the comparison of modified Ashworth scale (mAS) scores and goniometry measurements. Results and Conclusion: In a mean follow-up of 3.2 years, SDR provides a measurable and consistent improvement in the motor function of spastic patients, as per range of motion and tonus scales, with low complication rates. It also allows for patients to reduce their use of muscle relaxants, even though their global mobility does not change significantly. Therefore, it should be considered for CP patients who suffer with the deleterious effects of spasticity.

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“…In the United States, selective dorsal rhizotomy (SDR) has been utilized to treat cerebral palsy (CP) spasticity over the past three decades [1-3]. SDR is the only treatment that can permanently eradicate spasticity in patients with CP.…”

Section: Introductionmentioning

confidence: 99%

Beneficial Effects of Childhood Selective Dorsal Rhizotomy in Adulthood

Park¹,

Edwards²,

Liu³

et al. 2017

Cureus

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Background: Selective dorsal rhizotomy (SDR) has been used to treat children with spastic cerebral palsy (CP) for over three decades. However, little is known about the outcomes of childhood SDR in adults. Objectives: 1) To study the effects of childhood SDR on the quality of life and ambulatory function in adult life. 2) To determine late side effects of SDR in adults. Methods: Adults (> 17.9 years) who underwent SDR in childhood (2 - 17.9 years) between 1987 and 2013 were surveyed in 2015. Patients completed a survey, including questions on demographic information, quality of life, health, surgical outcomes, motor function, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, work status, and side effects of SDR. Results: In our study population of 294 patients (18.0 - 37.4 years), patients received SDR during the ages of 2.0 - 17.9 years and were followed up 2.2 to 28.3 years after surgery. Eighty-four percent had spastic diplegia, 12% had spastic quadriplegia, and 4% had spastic triplegia. The majority (88%) of patients reported improved post-SDR quality of life and 1% considered the surgery detrimental. Most (83%) would recommend the procedure to others and 3% would not. However, patients who would not recommend SDR to others ambulated with a walker or were not ambulatory at all prior to SDR. The majority (83%) of patients improved (30%) or remained stable (53%) in ambulation. Twenty-nine percent of patients reported pain, mostly in the back and lower limbs, with a mean pain level of 4.4 ± 2.4 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in small areas of the lower limbs was reported by 8% of patients, though this did not affect daily life. Scoliosis was diagnosed in 28%, with 40% of these patients pursuing treatment. Whether scoliosis was related to SDR is not clear, though scoliosis is known to occur in patients with CP and also in the general population. Only 4% of patients underwent spinal fusion. Orthopedic surgeries were pursued by 59% of patients. The most common orthopedic surgeries were hamstring lengthenings (31%), Achilles tendon lengthenings (18%), adductor lengthenings (16%), and derotational osteotomies (16%). Twenty-four percent of all patients later underwent hip surgery and 8% had surgeries on their knees. Conclusion: Results of this study indicate that the beneficial effects of childhood SDR extend to adulthood quality of life and ambulatory function without late side effects of surgery.

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Selective Dorsal Rhizotomy

Cited by 9 publications

References 30 publications

Selective dorsal rhizotomy: A multidisciplinary approach to treating spastic diplegia

Selective dorsal rhizotomy: A multidisciplinary approach to treating spastic diplegia

Surgical results of selective dorsal rhizotomy for the treatment of spastic cerebral palsy

Beneficial Effects of Childhood Selective Dorsal Rhizotomy in Adulthood

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