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SIDR shows promising results in managing persistent radicular leg pain, but clinical studies evaluating the comparative cost-effectiveness of SIDR over SCS are required.
As per a prospectively followed case series published in 'The spine journal: official journal of the North American Spine Society', the selective intradural dorsal rhizotomy (SIDR) is a safe and effective method in patients with persistent monoradicular leg pain without the residual nerve root compression.
Lumbar disc surgery for radicular leg pain is one of the most commonly executed spine procedures with approximately 20 % of patients with poor outcomes. The complicated cases show persistent leg pain without residual nerve compression. Management of refractory cases is restricted to medical pain treatment, dorsal root ganglion stimulation and spinal cord stimulation (SCS). Good results are achieved by dorsal root ganglion stimulation and spinal cord stimulation (SCS) in only 50% of patients, however, the costs and complication rates associated with these procedures is high. Selective intradural dorsal rhizotomy (SIDR) is used as an alternative procedure, but it is abandoned due to poor results and readily available modern treatments
Sierk H. Bakker et al. conducted a
prospective case series to report the efficacy of SIDR for persistent
monoradicular leg pain without residual nerve root compression and
compare the results with those of SCS. Patients with persistent
monoradicular leg pain and no residual nerve root compression were
included in this study. Roland Disability Questionnaire (RDQ), Likert
Scale and Visual Analogue Scale (VAS) for leg pain were noted.
Treatment complications and patient consent for repeating the
procedure were documented. A total of 8 patients were selected and
SIDR was performed. The patients were followed prospectively, and
RDQ, VAS and Likert Scale for leg pain were noted at intake, at 8th
week and 1 year after the surgery and yearly afterwards. A time
period of 20 months was selected as mean follow-up period.
The results indicated an improvement in
VAS score from 80 mm at intake to 34 mm at the latest follow-up. Out
of a total of eight patients, five patients (63%) depicted a good
Likert Scale outcome (complete or near-complete recovery of leg
pain). The RDQ scores changed from 19, 5 at intake to 12, 7 at the
end of follow-up. Four patients (57%) reached an MCID for VAS at 1
year after the surgery and one reached borderline MCID. Five patients
(71%) achieved an MCID for RDQ at 1-year post-surgery. Six patients
(75%) would undergo this procedure again.
Keeping in mind the high costs and
complication rates of SCS, the results of this study warrant a
randomized controlled trial distinguishing the cost-effectiveness of
SIDR and SCS, noted the study investigators.
The spine journal: official journal of the North American Spine Society
Selective intradural dorsal rhizotomy for persistent radicular leg pain: a contemporary series
Sierk H. Bakker et al.
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