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Selective dorsal rhizotomy: current state of practice and the role of imaging

David Graham1,2, Kristian Aquilina3, Kshitij Mankad4

  • 1Faculty of Medicine, the University of Sydney, Sydney, Australia.

Quantitative Imaging in Medicine and Surgery
|April 21, 2018
PubMed

Insights

Selective dorsal rhizotomy (SDR) effectively reduces lower limb spasticity in children with spastic diplegic cerebral palsy (CP). This neurosurgical procedure offers positive long-term outcomes with minimal complications for carefully selected patients.

Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Rehabilitation Medicine

Background:

  • Spastic diplegic cerebral palsy (CP) is the most prevalent form of CP.
  • A tailored, goal-oriented management approach is crucial for all CP types.
  • Lower limb spasticity significantly impacts a child's development and mobility.

Purpose of the Study:

  • To describe the surgical technique of Selective Dorsal Rhizotomy (SDR).
  • To outline patient selection criteria for SDR.
  • To discuss the long-term outcomes and benefits of SDR in managing spastic diplegic CP.

Main Methods:

  • SDR involves a laminectomy at the conus level.
  • Intraoperative electromyography (EMG) guides selective division of afferent lumbosacral nerve roots.
  • Medical imaging is integral for precise patient selection and surgical planning.

Main Results:

  • SDR permanently reduces lower limb spasticity in carefully selected children.
  • Reduced spasticity positively influences the developmental trajectory of affected children.
  • The procedure is associated with minimal complications and favorable long-term results.

Conclusions:

  • Selective Dorsal Rhizotomy is a safe and effective neurosurgical intervention for spastic diplegic CP.
  • Careful patient selection and surgical technique are key to achieving optimal outcomes.
  • SDR offers significant long-term benefits for children with spastic diplegic cerebral palsy.

Keywords:
Cerebral palsy (CP)neuroimagingneurosurgerypediatricsselective dorsal rhizotomy (SDR)

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