• Samuel M T Jeffery, Balázs Markia, Ian K Pople, Kristian Aquilina, Jenny Smith, Amr Z Mohamed, Alison Burchell, Lyn Jenkins, Peter Walsh, Natasha Clark, Jenny Sacree, Mary Cramp, Mohamed O E Babiker, William Guy Atherton, Anna Clarke, and Richard J Edwards.
• Department of Neurosurgery, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Department of Neurosurgery, North Bristol NHS Trust, Bristol, United Kingdom; South West Neurosurgery Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, Devon, United Kingdom.
• World Neurosurg. 2019 May 1; 125: e60-e66.

ObjectivesSelective dorsal rhizotomy (SDR) is used to improve spasticity, gait, and pain in children with spastic diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence, and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single United Kingdom center.MethodsDemographics, surgical, postoperative, and follow-up data for all patients undergoing SDR between 2011 and 2016 were collected from medical records.ResultsPreoperative Gross Motor Function Classification System levels in 150 consecutive patients were II (35%), III (65%), and IV (1%). Median age was 6 years and 58% were male patients. There were no deaths, cerebrospinal fluid leaks, returns to theater, or readmissions within 30 days. There were no new motor or sphincter deficits. Postoperative neuropathic pain was reported by 5.3% and sensory symptoms by 8.7%. Other complications included: postoperative nausea and vomiting (19.3%), superficial wound infection (3.3%), urinary retention (1.3%), headache (6.7%), and urine or chest infection (4.7%). Follow-up data were available for all patients (93% to 12 months, 72% to 24 months). Persistent neuropathic symptoms were reported in 6.5% at 24 months.ConclusionsSDR using a single-level approach is a safe procedure with low surgical morbidity. This study complements the growing evidence base in support of SDR for spastic diplegia and should help inform decisions when considering treatment options.Copyright © 2019. Published by Elsevier Inc.

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