The role of selective dorsal rhizotomy in the management of post-traumatic spasticity: systematic review

Abstract

There is a huge burden of patients suffering from trauma-induced disabling spasticity the world over. There are surprisingly few modalities of treatment with a sustained, proven benefit which can be offered to such patients. Selective dorsal rhizotomy (SDR) has been used with proven success in treating spasticity in patients of cerebral palsy, both in children and in adults. The rationale behind using the procedure in post-traumatic cases is reviewed, along with the cases reported till date in the world literature. The indications, surgical procedure used, outcome and complications, if any, are described. Most of the cases described in the literature have shown a favourable outcome with minimal complications. SDR can become an important tool in the armamentarium of the clinician treating this condition.

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References

  1. 1.

    Dewan MC, Rattani A, Gupta S et al (2018) Estimating the global incidence of traumatic brain injury. J Neurosurg 1:1–18

    Google Scholar 

  2. 2.

    GBD (2016) Traumatic brain injury and spinal cord injury collaborators (2019) global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol 18(1):56–87

    Google Scholar 

  3. 3.

    Westerkam D, Saunders LL, Krause JS (2011) Association of spasticity and life satisfaction after spinal cord injury. Spinal Cord 49:990–994

    CAS  Article  Google Scholar 

  4. 4.

    Boster A, Nicholas J, Bartoszek MP, O'Connell C, Oluigbo C (2014) Managing loss of intrathecal baclofen efficacy: review of the literature and proposed troubleshooting algorithm. Neurol Clin Pract 4(2):123–130

    Article  Google Scholar 

  5. 5.

    Pucks-Faes E, Hitzenberger G, Matzak H et al (2018) Eleven years' experience with Intrathecal baclofen - complications, risk factors. Brain Behav 8(5):e00965

    Article  Google Scholar 

  6. 6.

    Wright FV, Shell EM, Drake JM et al (1998) Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 40:239–247

    CAS  Article  Google Scholar 

  7. 7.

    Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, Kestle J (1997) A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39:178–184

    CAS  Article  Google Scholar 

  8. 8.

    McLaughlin JF, Bjornson KF, Astley SJ, Graubert C, Hays RM, Roberts TS, Price R, Temkin N (1998) Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40:220–232

    CAS  Article  Google Scholar 

  9. 9.

    Wong AM, Pei YC, Lui TN, Chen CL, Wang CM, Chung CY (2005) Comparison between botulinum toxin type a injection and selective posterior rhizotomy in improving gait performance in children with cerebral palsy. J Neurosurg 102:385–389

    CAS  PubMed  Google Scholar 

  10. 10.

    Reynolds MR, Ray WZ, Strom RG, Blackburn SL, Lee A, Park TS (2011) Clinical outcomes after selective dorsal rhizotomy in an adult population. World Neurosurg 75:138–144

    Article  Google Scholar 

  11. 11.

    Nordmark E, Josenby AL, Lagergren J et al (2008) Long-term outcomes five years after selective dorsal rhizotomy. BMC Pediatr 8:54

    Article  Google Scholar 

  12. 12.

    Dudley RW, Parolin M, Gagnon B, Saluja R, Yap R, Montpetit K, Ruck J, Poulin C, Cantin MA, Benaroch TE, Farmer JP (2013) Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg Pediatr 12:142–150

    Article  Google Scholar 

  13. 13.

    Gump WC, Mutchnick IS, Moriarty TM (2013) Selective dorsal rhizotomy for spasticity not associated with cerebral palsy: reconsideration of surgical inclusion criteria. Neurosurg Focus 35(5):E6

    Article  Google Scholar 

  14. 14.

    Privat JM, Benezech J, Frerebeau P, Gros C (1976) Sectorial posterior rhizotomy, a new technique of surgical treatment for spasticity. Acta Neurochir (Wien) 35:181–195

    CAS  Article  Google Scholar 

  15. 15.

    Laitinen LV, Nilsson S, Fugl-Meyer AR (1983) Selective posterior rhizotomy for treatment of spasticity. J Neurosurg 58:895–899

    CAS  Article  Google Scholar 

  16. 16.

    Schijman E, Erro MG, Meana NV (1993) Selective posterior rhizotomy: experience of 30 cases. Childs Nerv Syst 9:474–477

    CAS  Article  Google Scholar 

  17. 17.

    Bertelli JA, Ghizoni MF, Michels A (2000) Brachial plexus dorsal rhizotomy in the treatment of upper-limb spasticity. J Neurosurg 93(1):26–32

    CAS  Article  Google Scholar 

  18. 18.

    Salame K, Ouaknine GER, Rochkind S, Constantini S, Razon N (2003) Surgical treatment of spasticity by selective posterior rhizotomy: 30 years experience. Isr Med Assoc J 5:543–546

    PubMed  Google Scholar 

  19. 19.

    Hsin YL, Harnod T, Kuo TBJ, Su CF, Lin SZ (2004) Selective cervical dorsal rhizotomy to relieve upper-limb spasticity after stroke or spinal cord injury-report of five cases. Tzu Chin Med J 16:371–375

    Google Scholar 

  20. 20.

    Oki A, Oberg W, Siebert B, Plante D, Walker ML, Gooch JL (2010) Selective dorsal rhizotomy in children with spastic hemiparesis. Clin Article J Neurosurg Pediatr 6:353–358

    Article  Google Scholar 

  21. 21.

    Reynolds RM, Morton RP, Walker ML, Massagli TL, Browd SR (2014) Role of dorsal rhizotomy in spinal cord injury-induced spasticity. J Neurosurg Pediatr 14(3):266–270

    Article  Google Scholar 

  22. 22.

    Duan Y, Luo X, Gao X, Sun C (2015) Cervical selective dorsal rhizotomy for treating spasticity in upper limb spasticity neurosurgical way to neurosurgical technique. InterdiscipNeurosurg 2:57–60

    Google Scholar 

  23. 23.

    Sitthinamsuwan B, Phonwijit L, Khampalikit I, Nitising A, Nunta-Aree S, Suksompong S (2017) Comparison of efficacy between dorsal root entry zone lesioning and selective dorsal rhizotomy for spasticity of cerebral origin. Acta Neurochir (Wien) 159(12):2421–2430

    Article  Google Scholar 

  24. 24.

    Maynard FM, Karunas RS, Waring WP (1990) Epidemiology of spasticity following traumatic spinal cord injury. Arch Phys Med Rehabil 71:566–569

    CAS  PubMed  Google Scholar 

  25. 25.

    Holtz KA, Lipson R, Noonan VK, Kwon BK, Mills PB (2017) Prevalence and effect of problematic spasticity after traumatic spinal cord injury. Arch Phys Med Rehabil 98(6):1132–1138

    Article  Google Scholar 

  26. 26.

    Mills PB, Holtz KA, Szefer E, Noonan VK, Kwon BK (2018) Early predictors of developing problematic spasticity following traumatic spinal cord injury: a prospective cohort study. J Spinal Cord Med 9:1–16

    Google Scholar 

  27. 27.

    Trompetto C, Marinelli L, Mori L, et al (2014) Pathophysiology of spasticity: implications for neurorehabilitation. Biomed Res Int , p. 354906

  28. 28.

    Behari M (2002) Spasticity. Neurol India 50:235

    CAS  PubMed  Google Scholar 

  29. 29.

    Sheean G (2008) Neurophysiology of spasticity. In: Barnes MP, Johnson GR (eds) Upper motor neurone syndrome and spasticity: clinical management and neurophysiology, vol 22, 2nd edn. Cambridge University press, Cambridge, pp 9–63

    Google Scholar 

  30. 30.

    Steinbok P (2007) Selective dorsal rhizotomy for spastic cerebral palsy: a review. Childs Nerv Syst 23:981–990

    Article  Google Scholar 

  31. 31.

    Park TS, Johnston JM (2006) Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Technical note. Neurosurg Focus 21(2):e7

    Article  Google Scholar 

  32. 32.

    Grunt S, Becher JG, Vermuelen RJ (2011) Long-term outcome and adverse effects of selective dorsal rhizotomy in children with cerebral palsy: a systematic review. DevMed Child Neurol 53:490–498

    Article  Google Scholar 

  33. 33.

    McLaughlin J, Bjornson K, Temkin N, Steinbok P, Wright V, Reiner A, Roberts T, Drake J, O'Donnell M, Rosenbaum P, Barber J, Ferrel A (2002) Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol 44:17–25

    Article  Google Scholar 

  34. 34.

    Abbott R, Johann-Murphy M, Shiminski-Maher T, Quartermain D, Forem SL, Gold JT, Epstein FJ (1993) Selective dorsal rhizotomy: outcome and complications in treating spastic cerebral palsy. Neurosurgery 33:851–857 discussion 857

    CAS  PubMed  Google Scholar 

  35. 35.

    Health Quality Ontario (2017) Lumbosacral dorsal Rhizotomy for spastic cerebral palsy: a health technology assessment. Ont Health Technol Assess Ser 17(10):1–186

    Google Scholar 

  36. 36.

    Nagel SJ, Wilson S, Johnson MD, Machado A, Frizon L, Chardon MK, Reddy CG, Gillies GT, Howard MA 3rd (2017) Spinal cord stimulation for spasticity: historical approaches, current status, and future directions. Neuromodulation 20(4):307–321

    Article  Google Scholar 

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Correspondence to Ramesh Doddamani.

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Agrawal, M., Samala, R., Doddamani, R. et al. The role of selective dorsal rhizotomy in the management of post-traumatic spasticity: systematic review. Neurosurg Rev 44, 213–221 (2021). https://doi.org/10.1007/s10143-020-01255-w

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Keywords

  • Selective dorsal rhizotomy
  • Post-traumatic spasticity
  • Review