Surgical outcomes of single level bilateral selective dorsal rhizotomy for spastic diplegia in 150 consecutive patients

Jeffery, Samuel M. T.; Markia, Balázs; Pople, Ian K.; Aquilina, Kristian; Smith, Jenny; Mohamed, Amr Z.; Burchell, Alison; Jenkins, Lyn; Walsh, Peter; Clark, Natasha; Sacree, Jenny; Cramp, Mary; Babiker, Mohamed O. E.; Atherton, William Guy; Clarke, Anna; Edwards, Richard J.

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 UK centre.

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 (GMFCS) levels in 150 consecutive patients were II (35%), III (65%) and IV (1%). Median age was 6 years and 58% were male. There were no deaths, CSF leaks, returns to theatre 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/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.

Conclusion: 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.

Citation

Jeffery, S. M. T., Markia, B., Pople, I. K., Aquilina, K., Smith, J., Mohamed, A. Z., …Edwards, R. J. (2019). Surgical outcomes of single level bilateral selective dorsal rhizotomy for spastic diplegia in 150 consecutive patients. World Neurosurgery, 125, e60-e66. https://doi.org/10.1016/j.wneu.2018.12.187

• Journal Article Type: Article
• Acceptance Date: Dec 23, 2018
• Online Publication Date: Jan 16, 2019
• Publication Date: May 1, 2019
• Deposit Date: Mar 8, 2019
• Publicly Available Date: Jan 17, 2020
• Journal: World Neurosurgery
• Print ISSN: 1878-8750
• Electronic ISSN: 1878-8769
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 125
• Pages: e60-e66
• DOI: https://doi.org/10.1016/j.wneu.2018.12.187
• Keywords: cerebral palsy, spastic diplegia, selective dorsal rhizotomy, complications, operative outcomes
• Public URL: https://uwe-repository.worktribe.com/output/853785
• Publisher URL: https://doi.org/10.1016/j.wneu.2018.12.187
• Additional Information: Additional Information : This is the author's accepted manuscript. The final published version is available here: https://doi.org/10.1016/j.wneu.2018.12.187.; Corporate Creators : Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, UK, North Bristol NHS Trust, UK, University of the West of England, Bristol, UK, University of Bristol, UK