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Predictors of postoperative complications after selective dorsal rhizotomy
Johannes Wach1, Ömer Can Yildiz2, Sevgi Sarikaya-Seiwert2
1Department of Neurosurgery, University of Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany. johannes.wach@ukbonn.de.
Insights
Selective dorsal rhizotomy (SDR) is a safe procedure for children with cerebral palsy (CP). Obesity is linked to wound complications and infections, while younger children face higher risks of cerebrospinal fluid leaks.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Selective dorsal rhizotomy (SDR) is a surgical procedure to reduce spasticity in children with cerebral palsy (CP).
- Potential preoperative predictors of complications following SDR require thorough investigation to optimize patient outcomes.
- Understanding these predictors is crucial for enhancing surgical safety and patient management.
Purpose of the Study:
- To identify preoperative predictors of complications after selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP).
- To analyze associations between patient characteristics and adverse events such as wound complications, cerebrospinal fluid (CSF) leaks, and prolonged pain management.
Main Methods:
- A retrospective analysis of 140 SDR procedures performed between March 2016 and July 2019 in children aged 2-17 years with CP.
- Statistical analysis of variables associated with wound dehiscence, infections, CSF leaks, and prolonged epidural pain management.
- Inclusion of ambulatory (GMFCS II-III) and non-ambulatory (GMFCS IV-V) patients to assess predictors across functional levels.
Main Results:
- Obesity (BMI z-score ≥ 1.64) significantly predicted prolonged wound healing (OR 24.4, p=0.003) and superficial surgical site infections (SSIs) (p=0.004).
- Cerebrospinal fluid (CSF) leaks occurred in 2.9% of patients and were associated with younger age (≤ 5 years, p=0.029).
- Prolonged epidural pain management (4-5 days) was required in 10.7% of patients and associated with non-ambulatory GMFCS levels (IV-V) (OR 3.6, p=0.008).
Conclusions:
- Selective dorsal rhizotomy (SDR) is a safe procedure across all Gross Motor Functional Classification System (GMFCS) levels in children with cerebral palsy (CP).
- Obesity is a key predictor for prolonged wound healing and surgical site infections (SSIs) post-SDR.
- While epidural pain management is safe, careful consideration is needed for non-ambulatory children due to increased requirements for prolonged pain management.
Background:
Selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy (CP). We analyzed potential preoperative predictors of complications after SDR via single-level laminectomy at the conus medullaris.
Methods:
One hundred and forty SDRs performed in children (2-17 years) with CP were included in this retrospective study (March 2016 to July 2019). Of these children, 69% were ambulatory (Gross Motor Functional Classification System (GMFCS) II and III). Variables associated with wound dehiscence and infections, cerebrospinal fluid (CSF) leaks, and prolonged epidural pain management were analyzed statistically.
Results:
Five children (3.6%) showed prolonged wound healing, which was associated with obesity (BMI z-score ≥ 1.64; odds ratio (OR) 24.4; 95% confidence interval (CI) 3-199; p = 0.003). Two cases (1.4%) had superficial surgical site infections (SSIs), which was associated with obesity (p = 0.004) and thrombocytopenia (< 180,000 G/l; p = 0.028). The area under the curve at ≥ 1.55 BMI z-score for SSI was 0.97 (95% CI 0.93-0.99, p = 0.024), with a sensitivity and specificity for SSI of 100 and 94.9%, respectively. CSF leaks occurred in four (2.9%) children, associated with age ≤ 5 years (p = 0.029). Fifteen (10.7%) children required prolonged (4-5 days) epidural pain treatment, which was associated with non-ambulatory GMFCS levels (IV and V) (OR 3.6; 95% CI 1.2-10.8; p = 0.008).
Conclusions:
SDR is safe for all GMFCS levels. Obesity predicts prolonged wound healing and SSI. Prolonged pain management via epidural pain catheter is safe, but care should be taken with non-ambulatory children.
