A systematic review of complications following selective dorsal rhizotomy in cerebral palsy

Mishra, Dipun; Barik, Sitanshu; Raj, Vikash; Kandwal, Pankaj

doi:10.1016/j.neuchi.2023.101425

Cited by 4 publications

(6 citation statements)

References 36 publications

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“…Like any surgical operation, SDR carries a high risk of complications such as infection, bleeding, or nerve damage. [9][10][11] Postoperative sensory disturbances or bladder dysfunctions are common, and patients usually require prolonged rehabilitation to maximize functional capabilities. These limitations stimulate the search for less invasive, safer, and equally effective treatment methods for spasticity in CP.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 RF destruction can be performed percutaneously through a small skin puncture, unlike traditional surgical rhizotomy that requires a multilevel laminectomy. 11 The minimally invasive nature of RF ablation makes it an attractive option, especially in the pediatric population, where more aggressive interventions may carry greater risk. This method has shown promise in early research and clinical applications, offering potential benefits such as reduced muscle tone and improved pain control.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Although SDR can be highly effective, it requires multilevel laminectomies that increase surgical risks, including CSF leaks, infection, hematomas, and spinal deformity. [9][10][11] The extensive dissection also leads to significant postoperative pain and a longer rehabilitation process.…”

mentioning

confidence: 99%

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Percutaneous thermal radiofrequency rhizotomy of L2–S1 spinal nerve roots in children with cerebral palsy

Shapkin,

Iakimov,

Sufianov

et al. 2024

Neurosurgical Focus

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OBJECTIVE This study presents the results of an evaluation of the effectiveness of percutaneous thermal radiofrequency (RF) ablation of spinal nerve roots to reduce spasticity and improve motor function in children with cerebral palsy (CP). METHODS A retrospective analysis was conducted on the surgical treatment outcomes of 26 pediatric patients with severe CP (Gross Motor Function Classification System levels IV–V). The assessment protocol included muscle tone assessment using the modified Ashworth scale (MAS), evaluation of passive and active range of motion, gait video recording, and locomotor status evaluation using the Gross Motor Function Measure (GMFM)–88 scale. Thermal RF rhizotomy (ablation of spinal nerve roots) was performed on all patients at the L2–S1 levels at 70°C for 90 seconds. The statistical data analysis was conducted using the t-test and Mann-Whitney U-test. A p value < 0.05 was considered statistically significant. RESULTS Before the operation, the average level of spasticity in the lower-limb muscles of all patients was 3.0 ± 0.2 according to the MAS. In the early postoperative period, the spasticity level in all examined muscle groups significantly decreased to a mean of 1.14 ± 0.15 (p < 0.001). In the long-term postoperative period, the spasticity level in the examined muscle groups averaged 1.49 ± 0.17 points on the MAS (p < 0.001 compared to baseline, p = 0.0416 compared to the early postoperative period). Despite the marked reduction of spasticity in the lower limbs, no significant change in locomotor status according to the GMFM-88 scale was observed in the selected category of patients. In the long-term period, during the control examination of patients, the GMFM-88 level increased on average by 3.6% ± 1.4% (from 22.2% ± 3.1% to 25.8% ± 3.6%). CONCLUSIONS The findings of this study offer preliminary yet compelling evidence that RF ablation of spinal nerve roots can lead to a significant and enduring decrease in muscle tone among children with severe spastic CP. Further studies and longer-term data of the impact on functionality and quality of life of patients with CP after spinal root RF ablation are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Percutaneous thermal radiofrequency rhizotomy of L2–S1 spinal nerve roots in children with cerebral palsy

Shapkin,

Iakimov,

Sufianov

et al. 2024

Neurosurgical Focus

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“…SDR is a safe and effective surgical approach for reducing muscle spasticity in the lower limbs of children with spastic CP ( 25 ). The patients included in this study demonstrated a significant improvement in TMA after the surgery, with a statistically significant increase in values compared to the preoperative period.…”

Section: Discussionmentioning

confidence: 99%

Short-term change of tibial torsion in children with spastic cerebral palsy after selective dorsal rhizotomy

Wang,

Jiang,

Wei

et al. 2023

Transl Pediatr

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Background Spastic cerebral palsy (CP) is a prevalent cause of motor dysfunction in children, with patients often experiencing secondary musculoskeletal deformities, including tibial torsion. This study aimed to investigate the short-term effect of selective dorsal rhizotomy (SDR) on tibial torsion in children with spastic CP. Methods We conducted a retrospective review of children with spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children’s Hospital, between July 2019 and November 2022. Pre- and post-operative physical assessments were examined. Results A total of 148 children were included in the study. After SDR, there was a significant decrease in muscle tone in the lower limb muscle groups. Joint range of motion in the lower limbs also increased post-surgery. Bilateral transmalleolar angle (TMA) showed a significant increase after the surgery, and 21% limbs classified as internal tibial torsion before SDR changed into normal angle post-operatively. Limbs with better improvement after SDR derived from younger patients and had lower muscle tone in the hamstring muscles when compared to those that did not show improvement. Conclusions SDR has the potential to increase TMA in children with spastic CP. Limbs classified as internal tibial torsion are more likely to improve after SDR if they have lower muscle tone in the hamstring muscles and are derived from younger patients.

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“…7 However, even with modern surgical approaches, dorsal rhizotomy carries a complication profile including scoliosis in more than 20% of pediatric patients, constipation in more than 10%, and a small risk of sensory changes or urinary incontinence. 8 Similarly to the procedure itself, these complications are often irreversible. Although they are reversible, intrathecal baclofen pumps similarly carry high complication rates; 41% across the literature, including infection and device malfunction.…”

Section: Focusmentioning

confidence: 99%

Neurosurgical treatment of spasticity: a potential return to the cerebellum

Cummins,

Park,

Panov

2024

Neurosurgical Focus

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OBJECTIVE Neurosurgical targeting of the cerebellar dentate nucleus via ablative dentatotomy and stimulation of the dentate nucleus was historically used for effective treatment of spasticity. Yet for decades, neurosurgical treatment of spasticity targeting the cerebellum was bypassed in favor of alternative treatments such as intrathecal baclofen pumps and selective dorsal rhizotomies. Cerebellar neuromodulation has recently reemerged as a promising and effective therapy for spasticity and related movement disorders. METHODS In this narrative review, the authors contextualize the historical literature of cerebellar neuromodulation, comparing it with modern approaches and exploring future directions with regard to cerebellar neuromodulation for spasticity. RESULTS Neurosurgical intervention on the cerebellum dates to the use of dentatotomy in the 1960s, which had progressed to electrical stimulation of the cerebellar cortex and dentate nucleus by the 1980s. By 2024, modern neurosurgical approaches such as tractography-based targeting of the dentate nucleus and transcranial magnetic stimulation of cerebellar cortex have demonstrated promise for treating spasticity. CONCLUSIONS Cerebellar neuromodulation of the dentate nucleus and cerebellar cortex are promising therapies for severe cases of spasticity. Open areas for exploration in the field include the following: tractography-based targeting, adaptive cerebellar stimulation, and investigations into the network dynamics between the cerebellar cortex, deep cerebellar nuclei, and the subcortical and cortical structures of the cerebrum.

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A systematic review of complications following selective dorsal rhizotomy in cerebral palsy

Cited by 4 publications

References 36 publications

Percutaneous thermal radiofrequency rhizotomy of L2–S1 spinal nerve roots in children with cerebral palsy

Percutaneous thermal radiofrequency rhizotomy of L2–S1 spinal nerve roots in children with cerebral palsy

Short-term change of tibial torsion in children with spastic cerebral palsy after selective dorsal rhizotomy

Neurosurgical treatment of spasticity: a potential return to the cerebellum

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