PMID- 29981857
OWN - NLM
STAT- MEDLINE
DCOM- 20191213
LR  - 20191217
IS  - 1878-1632 (Electronic)
IS  - 1529-9430 (Linking)
VI  - 19
IP  - 2
DP  - 2019 Feb
TI  - Selective intradural dorsal rhizotomy for persistent radicular leg pain: a 
      contemporary series.
PG  - 306-313
LID - S1529-9430(18)30643-0 [pii]
LID - 10.1016/j.spinee.2018.06.364 [doi]
AB  - BACKGROUND: Lumbar disc surgery for radicular leg pain is one of the most 
      frequently performed spine procedures. In approximately 20% of patients poor 
      outcome is achieved. The most complex cases have persistent leg pain without 
      residual nerve root compression. Treatment for refractory cases is limited to 
      medical pain management, spinal cord stimulation (SCS), and dorsal root ganglion 
      stimulation. For the latter two, fair to good results are obtained in only 50% of 
      patients and costs and complication rates are high. An alternative surgical 
      procedure is selective intradural dorsal rhizotomy (SIDR). This procedure has 
      been largely abandoned, likely due to poor historic results and readily available 
      modern alternatives. PURPOSE: The goal of this paper is to report our results for 
      SIDR for persistent monoradicular leg pain without residual nerve root 
      compression and to compare the results with those of SCS. STUDY DESIGN: 
      Prospectively followed case series. PATIENT SAMPLE: Consecutive patients with 
      persistent monoradicular leg pain without residual nerve root compression. 
      OUTCOME MEASURES: Visual Analogue Scale (VAS) for leg pain, Roland Disability 
      Questionnaire, and Likert Scale for leg pain were recorded. Complications were 
      documented and patients were asked if, in retrospect, they would undergo the 
      procedure again. METHODS: In Haaglanden Medical Center, SIDR was performed on 
      eight consecutive patients with persistent monoradicular leg pain without 
      residual nerve root compression between December 2013 and September 2017. 
      Patients were followed prospectively and VAS for leg pain, Roland Disability 
      Questionnaire (RDQ), and Likert Scale for leg pain were recorded at intake, 8 
      weeks and 1 year after surgery and yearly after that. Minimal clinically 
      important differences (MCID) for VAS and RDQ were predefined. Means and ranges 
      were calculated and due to the small sample size further analysis was limited to 
      descriptive analysis. RESULTS: Mean follow-up was 20 months. VAS for leg pain 
      improved from 80 mm at intake to 34 mm at latest follow-up. Five out of eight 
      patients (63%) had good Likert Scale outcome (complete or near complete recovery 
      of leg pain). Patients scored 19, 5 on the RDQ at intake and 12, 7 at the end of 
      follow-up. Four patients (57%) reached a MCID for VAS at 1 year post surgery and 
      one reached borderline MCID. Five patients (71%) reached a MCID for RDQ at 1 year 
      post surgery. Six patients (75%) would undergo the procedure again. CONCLUSIONS: 
      SIDR is a safe and effective procedure in strictly selected patients with 
      persistent monoradicular leg pain without residual nerve root compression. 
      Considering the high costs and complication rates of SCS, the results of this 
      study warrant a randomized controlled trial comparing the cost-effectiveness of 
      SIDR and SCS.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Bakker, Sierk H
AU  - Bakker SH
AD  - Department of Neurosurgery, Haaglanden Medical Center, The Hague, The 
      Netherlands. Electronic address: s.h.bakker@lumc.nl.
FAU - van der Gaag, Niels A
AU  - van der Gaag NA
AD  - Department of Neurosurgery, Haaglanden Medical Center, The Hague, The 
      Netherlands.
FAU - de Ruiter, Godard C W
AU  - de Ruiter GCW
AD  - Department of Neurosurgery, Haaglanden Medical Center, The Hague, The 
      Netherlands.
FAU - Arts, Mark P
AU  - Arts MP
AD  - Department of Neurosurgery, Haaglanden Medical Center, The Hague, The 
      Netherlands.
LA  - eng
PT  - Journal Article
DEP - 20180706
PL  - United States
TA  - Spine J
JT  - The spine journal : official journal of the North American Spine Society
JID - 101130732
SB  - IM
CIN - Spine J. 2019 Oct;19(10):1746. PMID: 31563337
CIN - Spine J. 2019 Oct;19(10):1747. PMID: 31563338
MH  - Adult
MH  - Female
MH  - Humans
MH  - Leg
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*epidemiology
MH  - Radiculopathy/*surgery/therapy
MH  - Rhizotomy/adverse effects/*methods
MH  - Spinal Cord Stimulation/adverse effects
OTO - NOTNLM
OT  - Clinical
OT  - Functional outcome
OT  - Intradural
OT  - Neurosurgery
OT  - Prospective
OT  - Refractory radicular pain
OT  - Rhizotomy
EDAT- 2018/07/10 06:00
MHDA- 2019/12/18 06:00
CRDT- 2018/07/09 06:00
PHST- 2018/05/05 00:00 [received]
PHST- 2018/06/27 00:00 [revised]
PHST- 2018/06/28 00:00 [accepted]
PHST- 2018/07/10 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
PHST- 2018/07/09 06:00 [entrez]
AID - S1529-9430(18)30643-0 [pii]
AID - 10.1016/j.spinee.2018.06.364 [doi]
PST - ppublish
SO  - Spine J. 2019 Feb;19(2):306-313. doi: 10.1016/j.spinee.2018.06.364. Epub 2018 Jul 
      6.