gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Predictors of postoperative complications following selective dorsal rhizotomy – Are there stumbling blocks in patient selection?

Prädiktoren für postoperative Komplikationen nach der selektiven dorsalen Rhizotomie – Gibt es Stolpersteine in der Patientenauswahl?

Meeting Abstract

  • presenting/speaker Johannes Wach - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Ömer Can Yildiz - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Matthias Schneider - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Sevgi Sarikaya-Seiwert - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Hannes Haberl - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV103

doi: 10.3205/20dgnc105, urn:nbn:de:0183-20dgnc1057

Veröffentlicht: 26. Juni 2020

© 2020 Wach et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy (CP). Object of this study is to analyze potential preoperative predictors of surgical complications following SDR via a single-level laminectomy at the medullary conus.

Methods: 140 SDRs performed via a single-level laminectomy in children (2-18 years old) were included in this retrospective study from 03/2016 - 07/2019. 69% of the children with CP were ambulatory (GMFCS II&III). Univariate-, binary logistic regression-, and receiver operating characteristic analyses were performed with regard to variables potentially associated with wound dehiscences, wound infections, CSF leaks and prolonged pain management via epidural catheters.

Results: Prolonged wound healing disorders were seen in 5 children (3.6%). Obesity (BMI-percentile ≥ 95th) was statistically significant associated with delayed wound healing in the binary logistic regression analysis (OR:24.4; 95% CI:3-199;p=0.003).

2 (1.4%) superficial wound infections were observed. Obesity (p=0.004) and thrombocytopenia (<180.000 G/l; p=0.028) were associated with wound infections in the two-sided Fisher´s exact test. AUC of BMI-percentile regarding SSI was 0.97 (95%CI:0.94-0.99, p=0.023). Sensitivity and specifity to observe a SSI were 100 % and 95.6 % if cut-off is set at ≥93th BMI percentile.

CSF leaks were seen in 4 (2.9%) children. Pearson’s (two-sided) chi-squared test analyzed that an age ≤ 5 is associated with CSF leaks (p=0.029).

15 (10.7%) children required prolonged (4&5 days) pain treatment using epidural catheters. Non-ambulatory GMFCS levels (IV&V) were statistically significant associated with prolonged epidural pain treatment following SDR in binary logistic regression analysis (p=0.008; OR: 3.6; 95% CI:1.2-10.8).

Conclusion: SDR is a safe procedure among all GMFCS levels. Obesity is a predictor for prolonged wound healing and SSI. Prolonged pain management via epidural pain catheters is safe but has to be reminded in non-ambulatory children (GMFCS level IV&V).