Utility of Magnetic Resonance Imaging of the Entire Neuro-axis in Selective Dorsal Rhizotomy Candidates

Introduction: Pediatric spasticity patients being evaluated for Selective Dorsal Rhizotomy (SDR) often have concomitant structural neurological abnormalities which may affect surgical candidacy. Magnetic resonance imagining (MRI) of the entire neuro-axis is not routinely obtained at many centers across the country. Pre-operative MRI of the brain and entire spine may reveal disqualifying or modifiable abnormalities. The objective of this study is to retrospectively review the utility of pre-operative MRI brain and entire spine in SDR candidates to evaluate for disqualifying or surgically modifiable factors

Methods: All pediatric patients with spastic cerebral palsy who underwent evaluation for SDR at our institution’s comprehensive multidisciplinary spasticity center between 2018 and 2024 were retrospectively reviewed. Medical records were utilized for data collection. Descriptive analysis was performed.

Results: 311 patients with spastic cerebral palsy were identified with an average age of 11.67 years. 311 were initially screened for SDR. Amongst screened patients for SDR, 7 (2.25%) were found to have a sizable syrinx. These patients were counseled against SDR due to risk of complete sensory loss. Additionally, 13 (10.16%) were found to have tethered spinal cord and underwent de-tethering prior to SDR.

Conclusion : Robust pre-operative multidisciplinary evaluation is critical for appropriate patient selection. MRI of the entire neuro-axis can reveal disqualifying, modifiable risk factors, or pathologies that warrant treatment in SDR candidates and should be considered the standard of care in the modern era.