245. Comparison of a Single Institutional Experience Between Multiple and Limited Laminoplasty Selective Dorsal Root Rhizotomy

Authors: Leopold Arko IV, MD; Raquel Wescott; Taemin Oh, MD; Peter Sun, MD; Kurtis Auguste, MD; lauren Ostling, MD (Boston, MA)

Introduction:

Selective dorsal root rhizotomy provides a reduction in spasticity to a diffuse set of muscle groups. This technique was first described as a multiple laminectomy technique (L2-S2) to separate each root of interest. A more limited technique has now been adopted with limited 1-2 level laminectomy to expose the conus medullaris and lumbosacral nerve roots. Here we directly compare our experience with both techniques.

A retrospective chart review was completed of patients with a completed selective dorsal root rhizotomy at Benioff Children’s Hospital Oakland from 2008-2018. Two cohorts were compared based on the performance of a limited 1-2 level laminoplasty (LL) compared to a L2-S2 multiple level laminoplasty technique (ML). Non-parametric Mann-Whitney U test was used to compare continuous variables.p>

Results:

45 patients had a limited laminoplasty, while 17 patients underwent a multiple level laminoplasty. There was not a significant difference between age of operation(ML Mdn= 8 yrs, LL Mdn=7 yrs)(P=0.855), estimated blood loss ( ML Mdn=22.5 cc, LL Mdn=20.0cc)(P=0.770), or length of hospital stay ( ML Mdn=5 days, LL Mdn=6 days)(P=0.600). The length of operation was significantly shorter with the limited laminoplasty technique (ML Mdn= 404 min, LL Mdn= 328 min)(P=0.006). p>

Conclusion:

 This is one of the few studies with a direct comparison of the limited laminoplasty SDR technique compared to the multiple laminoplasty SDR technique. The limited laminoplasty technique has allowed for shorter operative time, and presumably cost savings, in comparison with the multiple level laminoplasty technique. Further evaluation will be needed to assess if this changes patients’ rehabilitative course. .