Infra-Conus Single-Level Laminectomy for Selective Dorsal Rhizotomy: Technical Advance

  title={Infra-Conus Single-Level Laminectomy for Selective Dorsal Rhizotomy: Technical Advance},
  author={James William Bales and Susan D. Apkon and Marisa B Osorio and Gregory A. Kinney and R. Aaron Robison and Erin Hooper and Samuel R. Browd},
  journal={Pediatric Neurosurgery},
  pages={284 - 291}
Background/Aims: Selective dorsal rhizotomy for spastic cerebral palsy is an effective and well-validated surgical approach. Multiple techniques have been described in the past including multiple laminectomies and a single-level laminectomy at the level of the conus. There is considerable technical challenge involved with a single-level laminectomy approach. Methods: We report here a modification of the single-level laminectomy that selectively analyzes each individual nerve root with… 

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A descriptive set of normative data is provided to help guide the single-level SDR procedure, including physiological threshold values used to dissociate ventral from dorsal roots; response characteristics of muscles; descriptions of abnormal physiological responses; and percentage of rootlets transected during surgery.
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SDR surgery is a reliable way to improve outcomes of patients with spastic CP and can be done carefully in patients as long as stringent selection criteria are used, however, more research and technological advancements are needed to help address associated complications.
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This review looks at the advances in the surgical technique, selective dorsal rhizotomy, used for the management of spasticity in children.
Cerebral Palsy
Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?
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Selective dorsal rhizotomy for spastic cerebral palsy: a review
  • P. Steinbok
  • Medicine, Psychology
    Child's Nervous System
  • 2007
SDR is the procedure of choice for treatment of spasticity in spastic diplegic CP and in selected children with spastic quadriplegic CP because Optimal selection and outcomes are achieved using a multidisciplinary approach.
Selective lumbosacral dorsal rhizotomy immediately caudal to the conus medullaris for cerebral palsy spasticity.
In 66 children with cerebral palsy, the operation reduced spasticity in the lower extremity without complications, e.g., motor weakness, neurogenic bladder, and sensory loss.
The validity of electrophysiological criteria used in selective functional posterior rhizotomy for treatment of spastic cerebral palsy.
It is concluded that contralateral and suprasegmental spread into the upper limbs, neck, and face, and incremental responses are probably valid criteria of abnormality in spasticity.
Reliability of intraoperative electrophysiological monitoring in selective posterior rhizotomy.
Intraoperative electrophysiological stimulation can be valuable in achieving a balance between elimination of spasticity and preservation of underlying strength in cerebral palsy.
Spondylolysis and spondylolisthesis after five-level lumbosacral laminectomy for selective posterior rhizotomy in cerebral palsy
It is postulated that the laminectomy, associated lordosis and increased mobility after rhizotomy may be factors in the causation.
Sectorial posterior rhizotomy, a new technique of surgical treatment for spasticity
A new concept of analysis and treatment of spasticity in lower limbs is reported, based on operative sectorial identification of the posterior rootlets subserving the “handicapping spasticsity” by electrophysiological stimulation, muscle testing, and B.M.G. studies.
Spinal Deformity After Selective Dorsal Rhizotomy in Ambulatory Patients With Cerebral Palsy
There was a higher incidence of spinal deformity after SDR than in normals and an historical control population, which warrants clinical and radiographic long-term follow-up.
Surgical treatment of spasticity in cerebral palsy.
The best results have been obtained with functional posterior rhizotomy, an original modification of Foerster's technique, in which the selection of the roots/rootlets to be sectioned is based on functional exploration of the spinal circuits involved in the maintenance of spasticity.
Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy.
The relatively high incidence of spinal deformity in children who have undergone SDR via multi-level lumbosacral laminoplasties should raise some concern.