Selective Dorsal Rhizotomy: Analysis of two rootlet sectioning techniques

Abstract

Abstract Objective To analyze and compare the efficacy of two selective dorsal rhizotomy (SDR) techniques with intraoperative neurophysiological monitoring, using instrumented three-dimensional gait analysis. Introduction: SDR is a common, irreversible surgical treatment increasingly used to address gait disturbances in children with chronic non-progressive encephalopathy by reducing spasticity. Various techniques have been used, which mainly differ in the percentage of rootlets selected to be sectioned. A greater proportion of rootlets sectioned leads to a better reduction of spasticity; however, there is a potential risk of unwanted neurological effects of excessive deafferentation. While there is evidence of the short- and long-term benefits and complications of SDR, no studies have compared the effectiveness of each technique regarding gait function and preservation of the force-generating capacity of the muscles. Materials and methods Instrumented three-dimensional gait analysis was used to evaluate two groups of patients with spastic cerebral palsy treated by the same neurosurgeon in different time periods, initially using a classic technique (cutting 50% of the nerve rootlets) and subsequently a conservative technique (cutting no more than 33% the nerve rootlets). Results In addition to an increase in knee joint range of motion (ROM), in children who underwent SDR with the conservative technique a statistically significant increase (p = 0.04) in the net joint power developed by the ankle was observed. Patients who underwent SDR with the conservative technique developed a maximum net ankle power of 1.37 ± 0.61 [unit: W/BW], whereas those who were operated with the classic technique developed a maximum net joint power of the ankle of 0.98 ± 0.18 [unit: W/BW]. Conclusion Our results show that both techniques led to a reduction in spasticity with a positive impact on the gait pattern. In addition, patients treated with the conservative technique were able to develop greater net ankle joint power, leading to a better scenario for rehabilitation and subsequent gait.