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Complications after selective posterior rhizotomy for spasticity in children with cerebral palsy
1Division of Neurosurgery, Department of Surgery, University of British Columbia, and Division of Neurosurgery, Section of Surgery, British Columbia's Children's Hospital, Vancouver, Canada. psteinbok@wpog.childhosp.bc.ca
Insights
Selective dorsal rhizotomy (SDR) for cerebral palsy spasticity has potential side effects, including sensory changes and bladder/bowel issues. Careful surgical technique may reduce long-term complications.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Selective dorsal rhizotomy (SDR) is an established treatment for spasticity in cerebral palsy.
- Limited research exists on the specific side effects and complications associated with SDR.
Purpose of the Study:
- To determine the frequency and nature of complications following selective dorsal rhizotomy (SDR) in children with cerebral palsy.
- To identify potential risk factors and protective measures for SDR-related side effects.
Main Methods:
- Retrospective study of 158 children who underwent SDR between 1987 and 1996.
- Analysis of intraoperative, perioperative, and post-discharge complications.
- Evaluation of long-term outcomes, including sensory changes and sphincter dysfunction.
Main Results:
- Complication rates were 3.8% intraoperatively, 43.6% perioperatively, and 30% post-discharge.
- Common complications included sensory changes (8.9% perioperative, 13.9% post-discharge) and neurogenic bladder/bowel issues (12.7% post-discharge).
- Persistent sensory changes and sphincter dysfunction were infrequent, with potential links to surgical extent and monitoring techniques.
Conclusions:
- SDR is associated with a range of complications, necessitating careful patient counseling.
- Modifications such as pudendal monitoring and limiting S2 root resection may decrease long-term sphincter dysfunction.
- Further research into SDR complications can refine surgical techniques and inform treatment decisions for spastic cerebral palsy.
Abstract:
Selective dorsal rhizotomy (SDR) has been shown to be an effective treatment for the spasticity of cerebral palsy, but few studies have addressed specifically the side effects of the procedure. A retrospective study was performed to determine the frequency and nature of complications in 158 children who had undergone SDR at British Columbia's Children's Hospital from 1987 to 1996. Intraoperative, preoperative (immediate postoperative until discharge at approximately 7 days) and postdischarge complications occurred in 3.8, 43.6 and 30% of patients, respectively. The most common intraoperative complication was aspiration pneumonia, which was experienced by 2 patients (1.3%). Perioperatively, sensory changes were found in 8.9% of the children, and transient urinary retention in 4.4%. Complications after discharge included back pain starting more than 6 months after surgery in 10.8%, sensory changes in 13.9%, and neurogenic bladder or bowel problems in 12.7%. Persistent sensory changes occurred in 3.8%, were not important functionally, and tended to occur in patients with the largest amount of dorsal root tissue cut. In 8 patients (5.1%), bladder and/or bowel dysfunction attributed to the SDR was present at the latest follow-up, although in only 2 patients (1.3%) this dysfunction was a definite complication of the rhizotomy. The use of pudendal monitoring and/or cutting less than 50% of the S2 roots may have been associated with a lower incidence of long-term sphincter dysfunction. Data about the nature and frequency of complications may result in further modifications to the SDR procedure, and is critical for counseling about SDR and alternative options available for treatment of the child with spastic cerebral palsy.