Surgical Techniques of Selective Dorsal Rhizotomy for Spastic Cerebral Palsy

Tae Sung Park, MD; James M. Johnston, MD

Disclosures

Neurosurg Focus. 2006;21(2) 

In This Article

Abstract and Introduction

Abstract

Selective dorsal rhizotomy is a well-established surgical procedure for improving lower-extremity spasticity in children with cerebral palsy. The standard technique requires an L1–S1 laminectomy or laminoplasty for visualization of all dorsal nerve roots exiting at their respective foramina. The authors describe a rhizotomy procedure that requires a single-level laminectomy at the level of the conus, with the advantages of decreased operating time and postoperative pain as well as a minimal risk of progressive lumbar instability. This procedure is both effective and well tolerated in appropriately selected children and adults, and has had one cerebrospinal fluid lead requiring operative repair in more than 1500 patients treated at the authors´ institution since 1991.

Introduction

Cerebral palsy is a major neurological problem in children; it occurs in 1 of 500 live births and inflicts lifelong disabilities on those with the disorder. Among several factors contributing to the disabilities of patients with CP is spasticity. This condition affects nearly 80% of patients with CP, and once fully developed, it never resolves spontaneously. It hinders motor tasks in activities of daily living and also causes muscle contractures and orthopedic deformities in growing children. Selective dorsal rhizotomy reduces spasticity in patients with CP; this reduction facilitates the patients´ motor performance and alleviates orthopedic deformities. Several surgical techniques for SDR are currently used. The following is a description of an operation that includes an L-1 laminectomy, use of ultrasonography for localization of the conus medullaris, and partial deafferentation of L1–S2 roots with the aid of an operating microscope after EMG examination. We have performed this SDR in more than 1500 children and young adults since 1991.

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