Disclosures: Caroline Gormley:

Objective: A selective dorsal rhizotomy (SDR) is a neurosurgical procedure in children with cerebral palsy (CP) where L1-S2 sensory roots are divided at the conus or cauda equina levels and rootlets are transected reducing spasticity in lower extremities. Urinary retention has been reported in the acute postoperative period. This study investigates the incidence of urinary retention following an SDR and if the level of surgery, number of rootlets dissected, or percentage of rootlets transected increases this risk.

Design: Retrospective chart review Setting : Large pediatric rehabilitation hospital Participants : Children with CP who received an SDR between 2011-2018

Interventions: SDR at conus or cauda equina level

Main Outcome Measures: The correlation of bladder catheterization following an SDR with the level of SDR, percentage of rootlets transected, or number of rootlets dissected.

Results: One-hundred ninety-two patients had an SDR, 45 at the conus level and 147 at the cauda equina level. Twenty percent (9/45) of patients with a conus level rhizotomy and 7 percent (10/147) with a cauda equina level rhizotomy were catheterized (chi-square p=0.009). There was no significant difference in the number of rootlets dissected in the catheterization group (range 75-298, mean 166) versus non-catheterization group (range 67-328, mean 151)(t-test, p=0.37) nor in the percentage of rootlets transected in the catheterization group (range 23%-47%, mean 33%) versus the non-catheterization group (range 19-59%, mean 35%)( t-test, p=0.16). Conclusions: The need for bladder catheterization following an SDR was not uncommon and a significantly higher risk in patients who received a conus versus cauda equina level SDR. There was no significant correlation with percentage of rootlets transected or number of rootlets dissected. Both conus and cauda equina level SDRs are relatively safe procedures, but may have different potential post-surgical complications.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/urinary-retention-following-selective-dorsal-rhizotomy-conus-versus-cauda-equina-level-surgery/