Discharge From the Acute Hospital Setting on Postoperative Day One Following Selective Dorsal Rhizotomy: An Illustrative Pediatric Case and Literature Review

A selective dorsal rhizotomy (SDR) is a neurosurgical procedure aimed at improving lower extremity spasticity in children. The traditional postoperative course involves strict bed rest for 24-48 hours and an acute hospital length of stay usually ranging between three and five days. We present the case of a seven-year-old male with cerebral palsy and right-sided spasticity secondary to a perinatal ischemic infarction in the left hemisphere. The patient underwent a right-sided SDR consisting of a one-level laminectomy at the conus medullaris. The medium-sized Anastoclip GC Closure System was used to close the dura. The patient was admitted to the intensive care unit postoperatively for one night and was not required to lie flat postoperatively. He was out of bed on postoperative day (POD) zero and engaged in physical therapy on POD one. This patient is the first post-SDR reported to be discharged from the acute hospital setting on POD one to inpatient rehabilitation. The patient was able to stand flat-footed bilaterally within four weeks of the SDR, although he reported continued balance issues with running and jumping. This case illustrates the potential to minimize the postoperative stay of SDR patients safely using Anastoclips, repleting the cerebrospinal fluid volume after rhizotomy with lactated Ringer's, and eliminating the postoperative bed rest.