Indications, feasibility safety and efficacy of dorsal rhizotomy at the level of the conus medullaris (conus deafferentation) in individuals with spinal cord injury.

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.