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Introduction Spasticity is the root cause of the functional limitations in cerebral palsy and it can be countered by various methods. Selective dorsal rhizotomy (SDR) is a procedure in which afferent fibers are ablated near the posterior root of the spinal cord leading to reduction of efferent excitation which thereby reduces spasticity. This involves identification of the rootlets during surgery through intraoperative electrical stimulation so that only those rootlets are ablated which contribute maximally to spasticity (1). Also, several functions have been reported to have improved post SDR which cannot be explained by traditional neural pathways like speech, cognition, upper limb function and visual attention (2). Earlier studies have shown the development of spinal deformities post SDR (3–5). Various other transient and non-transient side effects or complications have been reported in literature (6–8). The literature lacks a concise overview regarding the various possible complications which can occur secondary to SDR. The aim of this study is to systematically review the literature regarding the various possible complications post-SDR and present them concisely. Material and methods The current systematic review will be performed following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analysis). The protocol of the review will be registered on PROSPERO and Open Science Framework. A literature search using PubMed (http:// www. ncbi.nlm.nih.gov/pubmed), Embase (http:// www. elsevier.com/online- tools/embase) and Google Scholar will be done focusing on outcomes and complications of selective dorsal rhizotomy in cerebral palsy. The keywords ‘outcome’, ‘result’, ‘complication’, ‘selective posterior rhizotomy’, ‘functional posterior rhizotomy’ and ‘selective dorsal rhizotomy’ will be used. The search strategy [((outcome) OR (result) OR (complication)) AND ((selective posterior rhizotomy) OR (functional posterior rhizotomy) OR (selective dorsal rhizotomy))] will be used. The search will also be replicated using the appropriate MeSH terms. The following filters will be used to obtain the probable article candidates: humans and English, French and German. Additional articles will be identified through the ‘related articles’ feature. All bibliographies will be checked for further probable studies for inclusion. The full text will be obtained after the screening of the title and abstract. Final selection of the articles will be done and any disagreement on the process was resolved by a group discussion of the three authors (PK, SB, DM). Studies on SDR in cerebral palsy will be included. The studies to be included were to have used SDR for management of spasticity in patients of cerebral palsy. The long-term complications of SDR mentioned in the articles will be included in this study with special emphasis on spinal deformities. Exclusion criteria will be studies with less than 5 cases, technical notes, review articles, conference abstracts, conference papers, conference reviews, data papers, and editorials. Full texts of the eligible studies will be retrieved and data extracted in Microsoft Excel sheets. The studies will be graded according to Oxford Centre for Evidence- Based Medicine. References 1. Steinbok P, Reiner A, Beauchamp RD, Cochrane DD, Keyes R. Selective Functional Posterior Rhizotomy for Treatment of Spastic Cerebral Palsy in Children. Pediatr Neurosurg. 1992;18(1):34–42. 2. Mittal S, Farmer JP, Al-Atassi B, Montpetit K, Gervais N, Poulin C, et al. Impact of selective posterior rhizotomy on fine motor skills. Long-term results using a validated evaluative measure. Pediatr Neurosurg. 2002 Mar;36(3):133–41. 3. Peter JC, Hoffman EB, Arens LJ, Peacock WJ. Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy. Childs Nerv Syst. 1990 Jan 1;6(1):30–2. 4. Steinbok P, Hicdonmez T, Sawatzky B, Beauchamp R, Wickenheiser D. Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg. 2005 May;102(4 Suppl):363–73. 5. Ravindra VM, Christensen MT, Onwuzulike K, Smith JT, Halvorson K, Brockmeyer DL, et al. Risk factors for progressive neuromuscular scoliosis requiring posterior spinal fusion after selective dorsal rhizotomy. J Neurosurg Pediatr. 2017 Nov;20(5):456–63. 6. Bolster EA, van Schie PE, Becher JG, van Ouwerkerk WJ, Strijers RL, Vermeulen RJ. Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles. Dev Med Child Neurol. 2013 Jul;55(7):610–6. 7. Nordmark E, Josenby AL, Lagergren J, Andersson G, Strömblad LG, Westbom L. Long-term outcomes five years after selective dorsal rhizotomy. BMC Pediatr. 2008 Dec;8(1):54. 8. Sitthinamsuwan B, Phonwijit L, Khampalikit I, Nitising A, Nunta-aree S, Suksompong S. Comparison of efficacy between dorsal root entry zone lesioning and selective dorsal rhizotomy for spasticity of cerebral origin. Acta Neurochir (Wien). 2017 Dec;159(12):2421–30. |
