Selective dorsal rhizotomy: A multidisciplinary approach to treating spastic diplegia
Hussam Abou Al-Shaar1, Muhammad Tariq Imtiaz2, Hazem Alhalabi3, Shara M Alsubaie4, Abdulrahman J Sabbagh5
1 College of Medicine, Alfaisal University; Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
2 Department of Neurophysiology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
3 College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
4 Department of Physiotherapy, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
5 Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City; Faculty of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh;Department of Neurosciences, Division of Neurological Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
Muhammad Tariq Imtiaz,
Department of Neurophysiology, National Neurosciences Institute, King Fahad Medical City, P.O. Box 59046, Riyadh 11525
Source of Support: None, Conflict of Interest: None
Background: Spasticity is a motor disorder that interferes with mobility and affects the quality of life. Different approaches have been utilized to address patients with spastic diplegia, among which is selective dorsal rhizotomy (SDR). Although SDR has been shown to be efficacious in treating spastic patients, many neurologists and neurosurgeons are not well aware of the procedure, its indications, and expected outcomes due to the limited number of centers performing this procedure.
Objectives: The aim of this study is to describe the collaborative multidisciplinary approach between neurosurgeons, neurophysiologists, and physiotherapists in performing SDR. In addition, we delineate three illustrative cases in which SDR was performed in our patients.
Materials and Methods: A retrospective review and analysis of the clinical records of our three patients who underwent SDR was conducted and reported. Patients' outcomes were evaluated and compared to preoperative measurements based on clinical examination of power, tone (Ashworth scale), gait, and range of motion, as well as subjective functional assessment, gross motor function classification system, and gross motor function measure with follow-up at 6, 12, and 24 months postoperatively. A detailed description of our neurosurgical technique in performing SDR in collaboration with neurophysiology and physiotherapy monitoring is provided.
Results: The three patients who underwent SDR using our multidisciplinary approach improved both functionally and objectively after the procedure. No intraoperative or postoperative complications were encountered. All patients were doing well over a long postoperative follow-up period.
Conclusion: A multidisciplinary approach to treating spastic diplegia with SDR can provide good short-term and long-term outcomes in select patients suffering from spastic diplegia.