Selective Dorsal Rhizotomy for Posttraumatic Spasticity: A Prospective Case Series

Abstract

Background Spasticity following traumatic brain injury or spine injury is disabling and sometimes resistant to oral antispastic medications. It is painful and may lead to joint contractures. Selective dorsal rhizotomy, which is traditionally used in children with cerebral palsy, has limited evidence in posttraumatic spasticity.

Objective To evaluate the safety and efficacy of combined cervical and lumbar selective dorsal rhizotomy in patients with severe posttraumatic quadriparetic spasticity.

 Methods This was a prospective case series that included six patients (mean age 25  12.6 years; four males and two females) with drug-refractory quadriparetic spasticity following severe traumatic brain injury or cervical spine injury. The patients underwent cervical (C4–T1) and lumbar (L2–S2) dorsal rhizotomies under intraoperative neuromonitoring. Outcomes were assessed using the modified Ashworth scale (MAS), modified Rankin scale (mRS), reduction in antispastic drugs, functional gains, and complications, with follow-up to 12 months.

Results All patients showed significant reduction in spasticity (mean MAS 3.16  0.75 preoperatively to 0.5  0.54 postoperatively; p ¼ 0.03). Functional disability improved (mean mRS 4.83  0.37 to 2.67  1.03; p ¼ 0.03), with four patients achieving supported standing or ambulation. Drugs were reduced in all patients; one discontinued baclofen entirely. Two patients suffered pseudomeningoceles (resolved with conservative measures), one had transient weakness, and three patients had transient sensory symptoms.

Conclusion Cervical and lumbar selective dorsal rhizotomy is a safe and effective option for refractory posttraumatic spasticity. It provides durable reduction of tone, improvement in functions, and reduction in drugs.