Selective Lumbosacral Dorsal Rhizotomy Immediately Caudal to the Conus Medullaris for Cerebral Palsy Spasticity

Abstract

We describe a variation of selective dorsal rhizotomy for spastic cerebral palsy that involves sectioning of the dorsal spinal roots immediately caudal to the conus medullaris. The operation entails an L1-L2 laminectomy, ultrasonographic localization of the conus medullaris, and partial deafferentation of the L1-S2 roots with electromyographic testing under an operating microscope. 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. It offers several important advantages over alternative techniques.

Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature

“…However, some authors have questioned the usefulness of the electrophysiological methods used for the specific selection of nerve rootlets to be cut . Moreover, others have advocated laminotomies instead of laminectomies or have advocated reducing the number of laminectomies …”

Contralateral hemi‐fifth‐lumbar nerve transfer for unilateral lower limb dysfunction due to incomplete traumatic spinal cord injury: A report of two cases

“…The level of SCI was different between these two cases, in which case 1 suffered from flaccid paralysis and case 2 suffered from spastic paralysis. We combined a contralateral L5 transfer with SPR in patients with increased muscular tension according to methods described in the literature (Abdel et al, ; Fukuhara & Kamata, ; Park et al, ). In the second patient, who presented with spastic paralysis, a contralateral L5 transfer was combined with SPR and significantly reduced muscle tone.…”

“…The patient underwent a procedure in which half of the L5 nerve anterior root from the unaffected side was transferred to the S1 and S2 anterior roots on the affected side; this procedure combined with selective posterior rhizotomy (SPR) in which half of the posterior rootlets of L2–L5 were cut (Abdel et al, ; Fukuhara & Kamata, ; Park, Gaffney, Kaufman, & Molleston, ). Slightly decreased muscle strength, mild soreness, and discomfort on the donor side occurred in this patient, but these recovered within 12 months.…”

Effect of selective dorsal rhizotomy on need for orthopedic surgery for spastic quadriplegic cerebral palsy: long-term outcome analysis in relation to age

“…The technical details of SDR have been described previously. 18,19 Briefly, after induction of general anesthesia, needle electrodes were placed bilaterally in six major lowerextremity muscles in preparation for electromyographic examination. The lamina medial to the L-1 facet joint was removed, and ultrasonography was conducted to determine the location of the conus medullaris in relation to the laminectomy.…”