Samuel M T Jeffery1, Balázs Markia2, Ian K Pople3, Kristian Aquilina4, Jenny Smith5, Amr Z Mohamed3, Alison Burchell5, Lyn Jenkins5, Peter Walsh6, Natasha Clark7, Jenny Sacree3, Mary Cramp8, Mohamed O E Babiker9, William Guy Atherton10, Anna Clarke10, Richard J Edwards11. 1. Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom; South West Neurosurgery Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom. 2. Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; National Institute for Clinical Neurosciences, Budapest, Hungary. 3. Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom. 4. Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom; Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom. 5. Department of Paediatric Physiotherapy, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 6. Department of Neurophysiology, North Bristol NHS Trust, Bristol, United Kingdom. 7. Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 8. Centre for Health and Clinical Research, University of the West of England, Bristol, United Kingdom. 9. Department of Paediatric Neurology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 10. Department of Orthopaedic Surgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 11. Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom; School of Clinical Sciences, University of Bristol, Bristol, United Kingdom. Electronic address: Richard.Edwards2@UHBristol.nhs.uk.
Abstract
OBJECTIVES: Selective dorsal rhizotomy (SDR) is used to improve spasticity, gait, and pain in children with spastic diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence, and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single United Kingdom center. METHODS: Demographics, surgical, postoperative, and follow-up data for all patients undergoing SDR between 2011 and 2016 were collected from medical records. RESULTS: Preoperative Gross Motor Function Classification System levels in 150 consecutive patients were II (35%), III (65%), and IV (1%). Median age was 6 years and 58% were male patients. There were no deaths, cerebrospinal fluid leaks, returns to theater, or readmissions within 30 days. There were no new motor or sphincter deficits. Postoperative neuropathic pain was reported by 5.3% and sensory symptoms by 8.7%. Other complications included: postoperative nausea and vomiting (19.3%), superficial wound infection (3.3%), urinary retention (1.3%), headache (6.7%), and urine or chest infection (4.7%). Follow-up data were available for all patients (93% to 12 months, 72% to 24 months). Persistent neuropathic symptoms were reported in 6.5% at 24 months. CONCLUSIONS: SDR using a single-level approach is a safe procedure with low surgical morbidity. This study complements the growing evidence base in support of SDR for spastic diplegia and should help inform decisions when considering treatment options.
OBJECTIVES: Selective dorsal rhizotomy (SDR) is used to improve spasticity, gait, and pain in children with spastic diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence, and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single United Kingdom center. METHODS: Demographics, surgical, postoperative, and follow-up data for all patients undergoing SDR between 2011 and 2016 were collected from medical records. RESULTS: Preoperative Gross Motor Function Classification System levels in 150 consecutive patients were II (35%), III (65%), and IV (1%). Median age was 6 years and 58% were male patients. There were no deaths, cerebrospinal fluid leaks, returns to theater, or readmissions within 30 days. There were no new motor or sphincter deficits. Postoperative neuropathic pain was reported by 5.3% and sensory symptoms by 8.7%. Other complications included: postoperative nausea and vomiting (19.3%), superficial wound infection (3.3%), urinary retention (1.3%), headache (6.7%), and urine or chest infection (4.7%). Follow-up data were available for all patients (93% to 12 months, 72% to 24 months). Persistent neuropathic symptoms were reported in 6.5% at 24 months. CONCLUSIONS: SDR using a single-level approach is a safe procedure with low surgical morbidity. This study complements the growing evidence base in support of SDR for spastic diplegia and should help inform decisions when considering treatment options.
Authors: Johannes Wach; Ömer Can Yildiz; Sevgi Sarikaya-Seiwert; Hartmut Vatter; Hannes Haberl Journal: Acta Neurochir (Wien) Date: 2020-07-20 Impact factor: 2.216
Authors: Marcelo Volpon Santos; Vinicius M Carneiro; Patricia N B G C Oliveira; Carla A T Caldas; Helio R Machado Journal: J Pediatr Neurosci Date: 2021-06-25