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

Abstract

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.

A Cadaver Feasibility Study of Extradural Contralateral C7 Ventral Root Transfer Technique for Treating Upper Extremity Paralysis

“…The mechanism is similar to the selective posterior rhizotomy which has been extensively used in the treatment of spastic cerebral palsy. 35,36 Whether this novel CC7 nerve transfer technique can achieve the same therapeutic effects of a decrease in muscle tone as the selective posterior rhizotomy, remains unknown. Some researchers confirm that the muscle tone is controlled by the stretch reflex and the transection of the ventral roots destroys the efferent part of the stretch reflex.…”

“…In the traditional CC7 nerve transfer technique, the severance of the dorsal root on the affected side disrupts the afferent pathway of sensory feedback, resulting in a decrease in muscle tone on the affected side. The mechanism is similar to the selective posterior rhizotomy which has been extensively used in the treatment of spastic cerebral palsy 35,36. Whether this novel CC7 nerve transfer technique can achieve the same therapeutic effects of a decrease in muscle tone as the selective posterior rhizotomy, remains unknown.…”