• Zhexi He, Sui To Wong, Hing Yuen Law, Lai Mio Miko Lao, Kwai Fong Helen Chan, Nar Chi Nerita Chan, and Kwong Yui Yam.
• Department of Neurosurgery, Tuen Mun Hospital, New Territories, Hong Kong.
• Neurosurgery. 2022 Sep 1; 91 (3): 513-524.

BackgroundSelective dorsal rhizotomy (SDR) reduces lower limb spasticity, improves gait patterns, and restores normal physical and social activity in children with spastic cerebral palsy. Single-level laminectomy (SLL) and multiple-level laminotomy (MLL) are 2 surgical approaches for SDR with limited clinical data comparing their postoperative outcomes.ObjectiveTo compare the differences in multidimensional outcomes after SDR between SLL and MLL for children with spastic cerebral palsy.MethodsWe retrospectively reviewed children who underwent SDR in our hospital from 1997 to 2016. The multidimensional outcomes in spasticity, joint range of motions, gait kinetics, gross motor activities, functional outcomes, and urological outcomes were assessed 1 year postoperatively. Hip dysplasia and scoliosis rate were compared as long-term outcomes.ResultsSixty children underwent SDR, including 34 SLL patients and 26 MLL patients. Most improvements in multidimensional outcomes were comparable between SLL and MLL. Patients in the SLL group had larger improvements in ankle dorsiflexion in the midstance phase (SLL 7.59° ± 11.48° vs MLL 0.29° ± 11.30°, P = .027). The rate of scoliosis was similar between the 2 surgical approaches (SLL 12.1% vs MLL 15.4%, P = .722).ConclusionSDR for children with spastic cerebral palsy could provide physical, functional, and urological improvements. SLL achieved a higher degree of improvement in ankle dorsiflexion in the midstance phase. The rate of scoliosis was not significantly increased by multiple-level laminotomy.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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