Indications, feasibility safety and efficacy of dorsal rhizotomy at the level of the conus medullaris (conus deafferentation) in individuals with spinal cord injury.
Ines Kurze, Elena Jakisch, Martin Jakisch, Frank Werner, Birgitt Kowald, Klaus Golka, Ralf Böthig
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引用次数: 0
Abstract
Study design: Retrospective non-controlled intervention study.
Objectives: To assess indications, feasibility, safety and efficacy of dorsal rhizotomy at the level of conus medullaris (conus deafferentation - CDAF) in individuals with spinal cord injury/disease (SCI/D).
Setting: Two specialized tertiary German centers for spinal cord injuries.
Methods: In addition to a detailed description of the surgical procedure (including two technical variants: hemilaminectomy and osteoplastic laminotomy), an analysis of the surgical reports on intra- and postoperative complications and an evaluation of the pre- and postoperative paraplegiologic and neuro-urologic parameters of SCI/D patients with CDAF are presented.
Results: A total of 30 patients, 6 of them women, 22 with complete, 8 with incomplete SCI/D underwent CDAF. The most common indications were therapy-refractory detrusor overactivity, spasticity of the lower limbs and autonomic dysreflexia, usually with several simultaneous indications.Except for one antibiotic-treated wound infection, no severe CDAF-associated complications were documented. Urodynamic parameters (maximum detrusor pressure, maximum cystometric capacity) improved significantly (p < .001). In addition, all clinical targets (autonomic dysreflexia, spasticity triggered by bladder and bowel dysfunction, recurrent urinary tract infections, urinary incontinence) were also significantly improved.Quality of life (SCI-QoL-BDS) was significantly improved (p < .001) from 10 (IQR 6-16) to 17 (IQR 9.75-21), while neurogenic bowel dysfunction (NBD) score did not significantly change.
Conclusions: The present study identified different indications for the use of CDAF that can be performed safely and efficiently with very few intraoperative and postoperative complications. We see a high potential in this method for the improvement of the paraplegiological and neuro-urological therapy spectrum.
期刊介绍：
For more than three decades, The Journal of Spinal Cord Medicine has reflected the evolution of the field of spinal cord medicine. From its inception as a newsletter for physicians striving to provide the best of care, JSCM has matured into an international journal that serves professionals from all disciplines—medicine, nursing, therapy, engineering, psychology and social work.
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