Building a selective dorsal rhizotomy service in Shanghai: a retrospective evaluation of one team across two public tertiary children's hospitals, 2015 – 2026
This retrospective study of 1,312 patients across two Shanghai hospitals demonstrates that a single surgical team successfully sustained a high-volume selective dorsal rhizotomy service with a national catchment, while using adverse event data to identify and correct a technical cause of transient weakness and highlighting a significant documentation gap regarding reasons for non-surgical referrals.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many children born with cerebral palsy, the brain sends signals that keep muscles locked in a state of constant tightness, known as spasticity. This stiffness makes walking difficult, painful, and often impossible. For decades, surgeons have used a procedure called a selective dorsal rhizotomy to fix this. The surgery involves opening the spine to find the specific nerve roots that are firing the wrong signals and carefully cutting small portions of them. The goal is to loosen the muscles without causing weakness, allowing the child to move more freely. While the technique is well-known, it is performed in very few places around the world. Because it is so rare, doctors have not had a clear picture of how to run a large, successful service for it, or how to keep it safe when treating thousands of children over many years.
A team of surgeons in Shanghai decided to build such a service and then carefully study how it worked. Starting in 2015, they began performing these surgeries at a children's hospital in Shanghai and continued the work even after moving to a different hospital in 2023. Over eleven years, they treated 1,312 children, a number that grew steadily each year. The team did not just look at how well the children walked afterward; they looked at the entire journey. They tracked where the families came from, how long the children stayed in the hospital, and what happened to the children who were seen by doctors but never received the operation. Their goal was to understand the mechanics of running a high-volume center and to see if they could spot and fix problems as they happened.
The results showed that this service had become a national resource rather than a local one. Only a tiny fraction of the families lived in Shanghai itself. Most traveled from far away, with nearly half of the patients coming from more than 1,000 kilometers away. The team saw children from every province in China and even from other countries. Despite the distance, the system worked. The average time a child spent in the hospital for the surgery dropped significantly over the years, from eleven days down to seven. This change happened because the team stopped requiring families to stay in Shanghai for months of rehabilitation after the operation. Instead, they sent the children home to recover in their own provinces, which made the process much more practical for families traveling from distant places.
The researchers also paid close attention to safety, and their detailed records allowed them to solve a specific medical mystery. In the early years of the service, a small number of children developed temporary weakness in their right hip and thigh muscles after surgery. This weakness was not permanent; it went away on its own within a few months. However, the fact that it happened to the same muscles on the same side of the body in multiple children suggested a specific cause. By reviewing their own records, the team realized that the way they opened the spine to reach the nerves was likely the issue. The opening was positioned in a way that required them to pull on a specific nerve root to see it, which caused the temporary weakness. In 2020, they changed the position of the opening slightly higher up. After this adjustment, the problem disappeared completely. No child who had the surgery after the change experienced this specific type of weakness.
The study also highlighted a gap in their information. While they knew exactly what happened to the children who had the surgery, they did not know why most of the children who were seen in consultation did not proceed to the operation. Of the thousands of children the team evaluated, only about 18 percent ended up having the surgery. For the vast majority of the others, the medical records did not say why they stopped. The team did not call these families back to ask, as they did not want to pressure them. Consequently, the reasons remained unknown. It is possible that families chose other treatments, found the travel too difficult, or were told the child was not a good candidate, but the records simply did not capture these details.
Despite this missing information, the service proved that a single team could maintain a high standard of care while treating a large number of patients across a whole country. The team successfully identified a technical flaw in their own method and corrected it, preventing future complications. They also demonstrated that a specialized surgery could be delivered efficiently, with shorter hospital stays and high rates of follow-up care, even when patients lived thousands of kilometers away. The work shows that with careful record-keeping and a willingness to adapt, complex medical services can be built and sustained to reach children who need them most.
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