Selective Dorsal Rhizotomy: A Multidisciplinary Approach to Treating Spastic Diplegia

Overview

Journal Asian J Neurosurg

Specialty Neurology

Date 2017 Aug 2

PMID 28761524

Citations 2

Authors

Hussam Abou Al-Shaar

Muhammad Tariq Imtiaz

Hazem Alhalabi

Shara M Alsubaie

Abdulrahman J Sabbagh

Affiliations

Soon will be listed here.

Abstract

Background: Spasticity is a motor disorder that interferes with mobility and affects the quality of life. Different approaches have been utilized to address patients with spastic diplegia, among which is selective dorsal rhizotomy (SDR). Although SDR has been shown to be efficacious in treating spastic patients, many neurologists and neurosurgeons are not well aware of the procedure, its indications, and expected outcomes due to the limited number of centers performing this procedure.

Objectives: The aim of this study is to describe the collaborative multidisciplinary approach between neurosurgeons, neurophysiologists, and physiotherapists in performing SDR. In addition, we delineate three illustrative cases in which SDR was performed in our patients.

Materials And Methods: A retrospective review and analysis of the clinical records of our three patients who underwent SDR was conducted and reported. Patients' outcomes were evaluated and compared to preoperative measurements based on clinical examination of power, tone (Ashworth scale), gait, and range of motion, as well as subjective functional assessment, gross motor function classification system, and gross motor function measure with follow-up at 6, 12, and 24 months postoperatively. A detailed description of our neurosurgical technique in performing SDR in collaboration with neurophysiology and physiotherapy monitoring is provided.

Results: The three patients who underwent SDR using our multidisciplinary approach improved both functionally and objectively after the procedure. No intraoperative or postoperative complications were encountered. All patients were doing well over a long postoperative follow-up period.

Conclusion: A multidisciplinary approach to treating spastic diplegia with SDR can provide good short-term and long-term outcomes in select patients suffering from spastic diplegia.

Citing Articles

Combined intrathecal baclofen pump revision to the cervical level and lumbosacral ventral-dorsal rhizotomy for severe medically refractory hypertonia: illustrative cases.

Abdelmageed S, Bae G, Mossner J, Trierweiler R, Keen M, Katholi B J Neurosurg Case Lessons. 2025; 9(4).

PMID: 39869897 PMC: 11775990. DOI: 10.3171/CASE24599.

Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?.

Zhan Q, Yu X, Jiang W, Shen M, Jiang S, Mei R Childs Nerv Syst. 2019; 36(9):1935-1943.

PMID: 31502037 PMC: 7434794. DOI: 10.1007/s00381-019-04368-w.

Selective dorsal rhizotomy in cerebral palsy spasticity - a newly established operative technique in Slovenia: A case report and review of literature.

Velnar T, Spazzapan P, Rodi Z, Kos N, Bosnjak R World J Clin Cases. 2019; 7(10):1133-1141.

PMID: 31183344 PMC: 6547316. DOI: 10.12998/wjcc.v7.i10.1133.

References

Dasenbrock H, Pendleton C, McGirt M, Sciubba D, Ziya L Gokaslan , Quinones-Hinojosa A . "Fulfilling the chief of his duties as a physician": Harvey Cushing, selective dorsal rhizotomy and elective spine surgery for quality of life. J Neurosurg Spine. 2011; 14(3):421-7. PMC: 4612574. DOI: 10.3171/2010.10.SPINE10152. View

Steinbok P, Gustavsson B, Kestle J, Reiner A, Cochrane D . Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy. J Neurosurg. 1995; 83(1):18-26. DOI: 10.3171/jns.1995.83.1.0018. View

Harper C, Nelson K . Intraoperative electrophysiological monitoring in children. J Clin Neurophysiol. 1992; 9(3):342-56. DOI: 10.1097/00004691-199207010-00003. View

Grandjean H, Cans C, Du Mazaubrun C, Verrier A . Prevalence and time trends of disabilities in school-age children. Int J Epidemiol. 1997; 26(1):137-45. DOI: 10.1093/ije/26.1.137. View

Sherrington C . Decerebrate Rigidity, and Reflex Coordination of Movements. J Physiol. 1898; 22(4):319-32. PMC: 1513016. DOI: 10.1113/jphysiol.1898.sp000697. View

Grunt S, Fieggen A, Vermeulen R, Becher J, Langerak N . Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature. Dev Med Child Neurol. 2013; 56(4):302-12. DOI: 10.1111/dmcn.12277. View

Grunt S, Becher J, van Schie P, van Ouwerkerk W, Ahmadi M, Vermeulen R . Preoperative MRI findings and functional outcome after selective dorsal rhizotomy in children with bilateral spasticity. Childs Nerv Syst. 2009; 26(2):191-8. PMC: 2800177. DOI: 10.1007/s00381-009-0999-z. View

FASANO V, Ivaldi A, Sguazzi A . [Functional posterior radiculotomy, in the treatment of cerebral spasticity. peroperative electric stimulation of posterior roots and its use in the choice of the roots to be sectioned]. Neurochirurgie. 1976; 22(1):23-34. View

Russell D, Rosenbaum P, Cadman D, Gowland C, Hardy S, Jarvis S . The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol. 1989; 31(3):341-52. DOI: 10.1111/j.1469-8749.1989.tb04003.x. View

10.

Steinbok P . Selective dorsal rhizotomy for spastic cerebral palsy: a review. Childs Nerv Syst. 2007; 23(9):981-90. DOI: 10.1007/s00381-007-0379-5. View

11.

Oskoui M, Coutinho F, Dykeman J, Jette N, Pringsheim T . An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013; 55(6):509-19. DOI: 10.1111/dmcn.12080. View

12.

. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002; 44(9):633-40. View

13.

FASANO V, Zeme S, Squazzi A . Electrophysiological assessment of spinal circuits in spasticity by direct dorsal root stimulation. Neurosurgery. 1979; 4(2):146-51. DOI: 10.1227/00006123-197902000-00007. View

14.

Bennett W . A Case in which Acute Spasmodic Pain in the Left Lower Extremity was completely relieved by Sub-dural Division of the Posterior Roots of certain Spinal Nerves, all other treatment having proved useless. Death from Sudden Collapse and Cerebral.... Med Chir Trans. 2010; 72:329-348.3. PMC: 2121539. DOI: 10.1177/095952878907200119. View

15.

Krigger K . Cerebral palsy: an overview. Am Fam Physician. 2006; 73(1):91-100. View

16.

Peacock W, Arens L . Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J. 1982; 62(4):119-24. View

17.

Mittal S, Farmer J, Gibis J, Kennedy E, Galli C, Courchesnes G . Long-term functional outcome after selective posterior rhizotomy. J Neurosurg. 2002; 97(2):315-25. DOI: 10.3171/jns.2002.97.2.0315. View

18.

Steinbok P, Schrag C . Complications after selective posterior rhizotomy for spasticity in children with cerebral palsy. Pediatr Neurosurg. 1998; 28(6):300-13. DOI: 10.1159/000028668. View

19.

Williams P, Goldspink G . Longitudinal growth of striated muscle fibres. J Cell Sci. 1971; 9(3):751-67. DOI: 10.1242/jcs.9.3.751. View

20.

Peacock W, Staudt L . Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg. 1991; 74(3):380-5. DOI: 10.3171/jns.1991.74.3.0380. View