Complications of Therapies for Spasticity Treated with Selective Dorsal Rhizotomy in Children

Surgical

• Infections or CFS leak: There is always a 2-4% risk of wound infection with any surgery. In the experience of  the Montreal group none of , 0 of approximately 250 patients treated developed infection or CSF leak (50).
• Wound complications: These occur in about 2-4% of all surgical cases. Most are managed with local care measures and oral antibiotics, if needed. In the absence of CSF leak, deep infections are extremely rare
• Altered sensation: Sensory function appears preserved in detailed testing as long as as little as 20% of any given dorsal root is preserved. Some children may experience transient paresthesias or altered sensation in their legs after SDR. This is usually transient (50).
• 4% occurrence of scoliosis: With scoliosis defined as greater than a 10-degree abnormal curve in the spine, up to 45% of patients  scoliosis of >10%, but without rotatory component in most (9). Steinbok et al. (28) raised concern about increased incidence of spinal deformities in patients after SDR, but this is not reflected in the Cape Town long-term follow-up studies (45). One patient with severe involvement as a triplet (GMFCS IV) in the Montreal experience developed scoliosis that required orthopedic correction in adolescence. Both of her unaffected triplet siblings also have scoliosis to a lesser degree. No other patient required bracing or orthopaedic procedure, and all other curves, when present, were between 10 and 20 degrees. Hyperlordosis is a frequent finding in children operated after age 5 years but is not associated with functional limitations and has not required surgery.
• Risk for development of contractures: Despite these improvements, our patients do show decreased range of motion particularly in the hamstrings. This decreased range is particularly seen in children who are more involved (GMFCS 4) before they undergo surgery. However, this does not correlate with a reduction in their ambulatory gains, perhaps reflecting the natural history of joints to tighten up with time as demonstrated by natural history studies on the normal child development and the associated regressions in ranges of motion with age.
• Low incidence of urinary retention: Incidence of postoperative urinary retention has been reduced significantly to nearly zero with the use of a 24-hour delay between discontinuation of morphine and removal of the Foley catheter.Its believed that this allows sufficient metabolism of the morphine within the patient’s system that might interfer with micturation (50).
• Bladder or bowel incontinence: This is extremely rare in the modern era of SDR, but Foerster and Gros did report this in their earlier cases (23). With the advent of a meticulous nerve root mapping and use of detailed electrophysiology, it is extremely rare today.