Keyhole Interlaminar Dorsal Rhizotomy: Assessing the Feasibility, Efficacy, and Innocuity of the Technique in one Center

Objective

The objective of this article was to study the feasibility, efficacy, and innocuity and explore the nature of the complications of the keyhole interlaminar dorsal rhizotomy (KIDr) technique in the pediatric neurosurgery department in Nancy between 2018 and 2023.

Methods

We carried out a retrospective analysis of 62 children, who were operated on at our institution between January 2018 and December 2023, using a KIDr technique. We noted the duration of the surgery, as well as the intraoperative difficulties faced, which would help assess the feasibility of the surgical modality used. We also controlled the evolution of the spasticity using the Modified Ashworth Scale before and one year after the surgery, as well as the Gross Motor Function Classification System. We finally assessed the complications that occurred during the year that followed the procedure.

Results

In our series of 62 patients analyzed over 5 years, the average length of surgery was 250.3 minutes with a real learning curve. We had no complications during the procedure, except in 1 patient with a particular morphology. Prolonged electrophysiological monitoring was required in 8 patients but had no surgical consequences. During the first year that followed the surgery, we had a similar rate of complications to that of other selective dorsal rhizotomy (SDR) techniques described in the literature. The surgical efficacy was evaluated using the Gross Motor Function Classification System at one year, with 8 patients improving, with the others remaining clinically stable. The spasticity, which was assessed with the Modified Ashworth Scale at one year, showed a real improvement, going from an average score of 2.8 before the surgery to 0.53 afterward.

Conclusions

The KIDr shows similar results to other previously described SDR techniques in terms of operating time, intraoperative, and postoperative complications, functional results, and when it comes to the assessment of the spasticity at one year. It could be considered as a real surgical alternative to perform an SDR.