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Cervicothoracic dorsal rhizotomy for the management of upper limb spasticity: a systematic review
Camilla de Laurentis1,2, Corentin Dauleac3,4, Pierre-Aurélien Beuriat5,3
1Pediatric Neurosurgery Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59, Bd Pinel, 69003, Lyon, France. camilla.de-laurentis@chu-lyon.fr.
Abstract:
Lumbar selective dorsal rhizotomy (SDR) is a well-established surgical procedure for managing lower limb spasticity. However, its application for upper limb spasticity remains limited. This systematic review aims to analyze and synthesize the existing literature on cervicothoracic SDR for upper limb spasticity, focusing on surgical techniques, its effectiveness, and associated outcomes. A systematic literature review was conducted in PubMed, Scopus, and the Cochrane Library from inception to 2024, following PRISMA guidelines. Studies reporting at least one new case of cervicothoracic SDR for upper limb spasticity were included. Data extraction encompassed demographics, etiology, surgical details, pre- and postoperative spasticity and motor function assessments, and complications. Descriptive statistics and paired-sample t-tests were applied to assess outcomes, with statistical significance set at p < 0.05. A total of 10 studies (48 patients) met inclusion criteria. The mean age was 20.0 ± 13.3 years, with 60.4% pediatric patients. The most common etiologies were cerebral palsy (52.1%), traumatic brain injury (18.7%), and stroke (16.7%). SDR was unilateral in 75% of cases. The mean follow-up was 14.0 ± 7.3 months. Spasticity significantly decreased in 95.6% of patients (p < 0.001 for all muscle groups). Functional assessments demonstrated significant improvement in fine motor skills (p < 0.001), grasping strength (p = 0.005), and pinch strength (p = 0.003). Sensory deficits were reported in 35.3% of cases postoperatively. Complications included infection (2.1%), long-term neuropathic pain (6.3%), and spasticity recurrence (6.5%). Cervicothoracic SDR appears to be a promising surgical option for managing upper limb spasticity, with a favorable benefit-risk profile. Despite encouraging results, further prospective studies with standardized assessment protocols are required to refine patient selection criteria and optimize surgical outcomes.
