de Laurentis Camilla, Dauleac Corentin, Beuriat Pierre-Aurélien, Mertens Patrick
Pediatric Neurosurgery Unit, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59, Bd Pinel, 69003, Lyon, France.
Université Lyon 1, Université Claude Bernard, Lyon, France.
Neurosurg Rev. 2025 Nov 1;48(1):753. doi: 10.1007/s10143-025-03913-3.
Lumbar selective dorsal rhizotomy (SDR) is a well-established surgical procedure for managing lower limb spasticity. However, its application for upper limb spasticity remains limited. This systematic review aims to analyze and synthesize the existing literature on cervicothoracic SDR for upper limb spasticity, focusing on surgical techniques, its effectiveness, and associated outcomes. A systematic literature review was conducted in PubMed, Scopus, and the Cochrane Library from inception to 2024, following PRISMA guidelines. Studies reporting at least one new case of cervicothoracic SDR for upper limb spasticity were included. Data extraction encompassed demographics, etiology, surgical details, pre- and postoperative spasticity and motor function assessments, and complications. Descriptive statistics and paired-sample t-tests were applied to assess outcomes, with statistical significance set at p < 0.05. A total of 10 studies (48 patients) met inclusion criteria. The mean age was 20.0 ± 13.3 years, with 60.4% pediatric patients. The most common etiologies were cerebral palsy (52.1%), traumatic brain injury (18.7%), and stroke (16.7%). SDR was unilateral in 75% of cases. The mean follow-up was 14.0 ± 7.3 months. Spasticity significantly decreased in 95.6% of patients (p < 0.001 for all muscle groups). Functional assessments demonstrated significant improvement in fine motor skills (p < 0.001), grasping strength (p = 0.005), and pinch strength (p = 0.003). Sensory deficits were reported in 35.3% of cases postoperatively. Complications included infection (2.1%), long-term neuropathic pain (6.3%), and spasticity recurrence (6.5%). Cervicothoracic SDR appears to be a promising surgical option for managing upper limb spasticity, with a favorable benefit-risk profile. Despite encouraging results, further prospective studies with standardized assessment protocols are required to refine patient selection criteria and optimize surgical outcomes.
腰椎选择性背根切断术（SDR）是一种成熟的治疗下肢痉挛的外科手术。然而，其在上肢痉挛治疗中的应用仍然有限。本系统评价旨在分析和综合现有的关于颈胸段SDR治疗上肢痉挛的文献，重点关注手术技术、有效性及相关结果。按照PRISMA指南，于2024年在PubMed、Scopus和Cochrane图书馆进行了系统的文献综述。纳入报告至少1例颈胸段SDR治疗上肢痉挛新病例的研究。数据提取包括人口统计学、病因、手术细节、术前和术后痉挛及运动功能评估以及并发症。应用描述性统计和配对样本t检验评估结果，设定统计学显著性为p<0.05。共有10项研究（48例患者）符合纳入标准。平均年龄为20.0±13.3岁，儿科患者占60.4%。最常见的病因是脑瘫（52.1%）、创伤性脑损伤（18.7%）和中风（16.7%）。75%的病例为单侧SDR。平均随访时间为14.0±7.3个月。95.6%的患者痉挛明显减轻（所有肌肉群p<0.001）。功能评估显示精细运动技能（p<0.001）、抓握力（p=0.005）和捏力（p=0.003）有显著改善。术后35.3%的病例报告有感觉缺陷。并发症包括感染（2.1%）、长期神经性疼痛（6.3%）和痉挛复发（6.5%）。颈胸段SDR似乎是治疗上肢痉挛的一种有前景的手术选择，具有良好的效益风险比。尽管结果令人鼓舞，但仍需要进一步采用标准化评估方案的前瞻性研究，以完善患者选择标准并优化手术结果。
