Selective dorsal rhizotomy in children: comparison of outcomes after single-level versus multi-level laminectomy technique.
Children with cerebral palsy may experience spasticity, which may negatively impact their quality of life. One proven treatment for such spasticity is selective dorsal rhizotomy (SDR), whereby a partial sectioning of the dorsal roots from L2 to S1 is performed. SDR can be performed where the nerve root exits the intervertebral foramina via multi-level laminectomies, or at the level of the conus via a single-level laminectomy. At British Columbia Children's Hospital (BCCH), SDRs were performed via multi-level laminectomies until 2005, when the single-level technique was adopted. The single-level procedure is technically more challenging and takes longer, but requires a smaller incision and involves less muscle dissection. Functional outcomes at one-year follow-up are similar for the two methods of surgery. It was hypothesized that post-operative pain would be less, mobilization faster and hospital stay shorter using the single-level technique. Using a retrospective case series analysis, we compared nine patients who had had single-level SDR to 18 matched controls who had undergone SDR using the multi-level technique. There were no significant differences in post-operative pain, duration of opioid infusion, or time to mobilization. Length of hospital stay was significantly decreased after the single level procedure: 3.4 versus 5.2 days (p = 0.01).
Ou
Christine
C
Neurosciences and Surgery Unit, British Columbia Children's Hospital. cou@cw.bc.ca
Kent
Sarah
S
Miller
Stacey
S
Steinbok
Paul
P
D002547:Cerebral Palsy / Q000451:nursing* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods* / Q000451:nursing; D007902:Length of Stay; D008297:Male; D009043:Motor Activity; D010146:Pain / Q000451:nursing / Q000534:rehabilitation / Q000601:surgery; D010351:Patient Discharge; D010371:Pediatric Nursing / Q000379:methods*; D013527:Perioperative Nursing / Q000379:methods; D019051:Rhizotomy / Q000379:methods* / Q000451:nursing; D013126:Spinal Nerve Roots / Q000601:surgery