Related Experiment Video
Updated: Jul 16, 2026
Novel Surgical Rodent Model for Studying Neuroma Pain Treatment Options using Targeted Muscle Reinnervation Through the Saphenous Nerve
Published on: November 14, 2025
Selective dorsal rhizotomy and postoperative pain management. A worldwide survey
K Hesselgard1, P Reinstrup, L G Stromblad
1Department of Neurosurgery, University Hospital, Lund, Sweden. Karin.Hesselgard@skane.se
Insights
Selective dorsal rhizotomy (SDR) reduces spasticity in children with diplegia. Most centers use Peacock or Park techniques and manage severe postoperative pain with continuous opioid infusions and pain scales.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Pain Management
Background:
- Selective dorsal rhizotomy (SDR) is a surgical intervention for spastic diplegia in children, offering long-term benefits.
- Postoperative pain is a significant challenge following SDR due to extensive surgery and nerve manipulation.
- Effective pain management is crucial for optimizing outcomes in pediatric SDR patients.
Purpose of the Study:
- To determine the number of centers performing SDR globally.
- To assess the frequency of SDR procedures annually.
- To investigate and compare pain management strategies employed by different centers post-SDR.
Main Methods:
- A 7-question survey was distributed to 59 identified centers performing or publishing on SDR.
- A response rate of 80% (47 centers) was achieved, with 36 centers actively performing SDR surgery included in the study.
- Data on surgical techniques and postoperative pain management protocols were collected.
Main Results:
- Peacock's technique (23 centers) and Park's technique (8 centers) are the most common SDR methods.
- Continuous intravenous opioid infusion is utilized by 47% of centers for pain management.
- Epidural (19%) and intrathecal (17%) approaches are also employed, with pain relief durations up to 7 days. 70% of centers use pain scales.
Conclusions:
- Peacock and Park techniques dominate current SDR surgical practices, with over 487 procedures annually across 36 centers.
- Most centers appear to have effective pain management strategies in place for SDR patients.
- Common strategies include continuous opioid infusions (IV, epidural, or intrathecal) and the use of pain assessment tools.
Background:
Selective dorsal rhizotomy (SDR) is an operation method that decreases the degree of spasticity with long-lasting beneficial effects for children with spastic diplegia. Children undergoing SDR are postoperatively in severe pain, a pain related to both the extensive surgical exposure with multilevel laminectomy and the nerve root manipulation. Various pain management strategies for children undergoing SDR have been published. The postoperative pain treatment is a vital part of the management. The aim of this study was to estimate the number of centers performing SDR, the frequency of SDR surgery and to investigate pain management of the different centers.
Methods:
A questionnaire comprising 7 questions was sent by mail and/or e-mail to a total of 59 potential centers performing SDR, centers that have published material concerning SDR or centers that have been recommended. Forty-seven (80%) centers responded to the questionnaire; 11 of them do not presently perform SDR surgery, and the remaining 36 centers constitute the material of the present study.
Results:
23 of the 36 centers use Peacock's operation technique and 8 centers use Park's technique. Continuous intravenous infusion of opioids for postoperative pain treatment is used by 17 (47%) of the centers. Seven (19%) centers use the epidural (ED) approach for treating postoperative pain and 6 (17%) centers use intrathecal (IT) pain treatment. The duration of intravenous ED or IT pain relief ranged from 24 h up to 7 days. To evaluate pain relief, 25 (70%) centers used some form of pain scale.
Conclusion:
The most common operation techniques in use today are described by Peacock or by Park, with an estimated number of procedures of more than 487/year in 36 centers. The majority of the centers seem to have a satisfactory pain management strategy. These centers administer continuous infusions of opioids, with an intravenous, ED or IT approach, and incorporate the use of a pain assessment tool to evaluate pain relief.
