Selective dorsal rhizotomy from indication to rehabilitation: a worldwide survey.

Abstract

Purpose: Selective dorsal rhizotomy (SDR) is a neurosurgical treatment used worldwide to reduce spasticity. The procedure has undergone many changes since its introduction in the early 1900s, and currently, different centers vary in many aspects of the procedure. We surveyed centers on different continents regarding SDR indications, surgical techniques, and postoperative rehabilitation.

Methods: Ten centers worldwide with SDR experience participated in an online survey preparing for a pre-conference workshop in 2022. The main topics were patient characteristics, the selection process, surgery, and rehabilitation.

Results: Universal suitable candidates for SDR were patients with bilateral spastic cerebral palsy, Gross Motor Function Classification System levels II or III, ages 5 to 7 years, and adequate strength, motor control, and access to postoperative rehabilitation. Centers differed in additional inclusion and exclusion criteria and the use of diagnostic tools. Both single- and multilevel approaches were used, with electrophysiological monitoring applied in all approaches. Intensive rehabilitation was recommended after surgery, followed by a less intensive program, with variations in duration, therapy frequency, modalities used, and follow-up periods.

Conclusion: This survey demonstrated many similarities in several aspects of the SDR procedure in centers performing SDR worldwide, while considerable variability was also seen. The results emphasize the need for standardized reporting of SDR procedures and outcome measures to enable international comparative studies. A Delphi procedure could be a first step to reaching a consensus on outcome measurements, which may lead to a consensus regarding the most suitable candidates, surgical techniques, and rehabilitation programs to improve functional outcomes.