Selective dorsal rhizotomy: an illustrated review of operative techniques

Author:

Warsi Nebras M.12,Tailor Jignesh2,Coulter Ian C.2,Shakil Husain1,Workewych Adriana3,Haldenby Renée4,Breitbart Sara2,Strantzas Samuel2,Vandenberk Michael2,Dewan Michael C.2,Ibrahim George M.12

Affiliation:

1. Division of Neurosurgery, Department of Surgery, University of Toronto;

2. Division of Neurosurgery, Hospital for Sick Children;

3. Faculty of Medicine and

4. Department of Pediatrics, University of Toronto, Ontario, Canada

Abstract

OBJECTIVESelective dorsal rhizotomy (SDR) is a procedure primarily performed to improve function in a subset of children with limitations related to spasticity. There is substantial variability in operative techniques among centers and surgeons. Here, the authors provide a technical review of operative approaches for SDR.METHODSOvid MEDLINE, Embase, and PubMed databases were queried in accordance with PRISMA guidelines. All studies included described a novel surgical technique. The technical nuances of each approach were extracted, including extent of exposure, bone removal, and selection of appropriate nerve roots. The operative approach preferred at the authors’ institution (the “2 × 3 exposure”) is also detailed.RESULTSFive full-text papers were identified from a total of 380 articles. Operative approaches to SDR varied significantly with regard to level of exposure, extent of laminectomy, and identification of nerve roots. The largest exposure involved a multilevel laminectomy, while the smallest exposure involved a keyhole interlaminar approach. At the Hospital for Sick Children, the authors utilize a two-level laminoplasty at the level of the conus medullaris. The benefits and disadvantages of the spectrum of techniques are discussed, and illustrative figures are provided.CONCLUSIONSSurgical approaches to SDR vary considerably and are detailed and illustrated in this review as a guide for neurosurgeons. Future studies should address the long-term impact of these techniques on functional outcomes and complications such as spinal deformity.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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