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Selective dorsal rhizotomy in children: comparison of outcomes after single-level versus multi-level laminectomy
Christine Ou1, Sarah Kent, Stacey Miller
1Neurosciences and Surgery Unit, British Columbia Children's Hospital. cou@cw.bc.ca
Insights
Selective dorsal rhizotomy (SDR) for pediatric spasticity offers similar functional outcomes with both single-level and multi-level techniques. The single-level approach significantly reduces hospital stays for children with cerebral palsy.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Neurology
Background:
- Spasticity in children with cerebral palsy significantly impacts quality of life.
- Selective dorsal rhizotomy (SDR) is an effective treatment for pediatric spasticity.
- SDR can be performed using multi-level or single-level laminectomy techniques.
Purpose of the Study:
- To compare the outcomes of single-level versus multi-level SDR in pediatric patients.
- To evaluate post-operative pain, mobilization, and hospital stay after SDR.
- To determine if the technically more challenging single-level SDR offers clinical benefits.
Main Methods:
- Retrospective case series analysis.
- Comparison of nine patients undergoing single-level SDR with 18 matched controls undergoing multi-level SDR.
- Data collection on post-operative pain, opioid use, mobilization time, and hospital length of stay.
Main Results:
- No significant differences were observed in post-operative pain, opioid infusion duration, or time to mobilization between the two techniques.
- Length of hospital stay was significantly shorter for the single-level SDR group (3.4 days) compared to the multi-level SDR group (5.2 days).
- Functional outcomes at one-year follow-up were similar for both surgical approaches.
Conclusions:
- The single-level SDR technique, while more challenging, leads to a significantly shorter hospital stay for pediatric patients with cerebral palsy.
- Both single-level and multi-level SDR provide similar functional improvements for spasticity management.
- Further research may explore long-term benefits and patient-reported outcomes.
Abstract:
Children with cerebral palsy may experience spasticity, which may negatively impact their quality of life. One proven treatment for such spasticity is selective dorsal rhizotomy (SDR), whereby a partial sectioning of the dorsal roots from L2 to S1 is performed. SDR can be performed where the nerve root exits the intervertebral foramina via multi-level laminectomies, or at the level of the conus via a single-level laminectomy. At British Columbia Children's Hospital (BCCH), SDRs were performed via multi-level laminectomies until 2005, when the single-level technique was adopted. The single-level procedure is technically more challenging and takes longer, but requires a smaller incision and involves less muscle dissection. Functional outcomes at one-year follow-up are similar for the two methods of surgery. It was hypothesized that post-operative pain would be less, mobilization faster and hospital stay shorter using the single-level technique. Using a retrospective case series analysis, we compared nine patients who had had single-level SDR to 18 matched controls who had undergone SDR using the multi-level technique. There were no significant differences in post-operative pain, duration of opioid infusion, or time to mobilization. Length of hospital stay was significantly decreased after the single level procedure: 3.4 versus 5.2 days (p = 0.01).
