Selective dorsal rhizotomy in cerebral palsy spasticity-a newly established operative technique in Slovenia: A case report and review of literature

BACKGROUND Spasticity affects a large number of children,mainly in the setting of cerebral palsy,however,only a few paediatric neurosurgeons deal with this problem.This is mainly due to the fact that until 1979,when Fasano has published the first series of selective dorsal rhizotomy(SDR),neurosurgeons were able to provide such children only a modest help.The therapy of spasticity has made a great progress since then.Today,peroral drugs,intramuscular and intrathecal medicines are available,that may limit the effects of the disease.In addition,surgical treatment is gaining importance,appearing in the form of deep brain stimulation,peripheral nerve procedures and SDR.All these options offer the affected children good opportunities of improving the quality of life.CASE SUMMARY A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy.Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles.Then,the SDR was made.CONCLUSION We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.

Treatment of Iimb spasticity by selective nerve root rhizotomy

Objective To study a new surgical technique to reduce spasticity of upper and lower extremities.Methods: Selective brachial plexus and lumber nerve roots rhizotomy was designed to reduce spasticity in 9cases by utilizing the characteristics of brachial plexus roots and their functional anatomy. Result: Spasticitywas reduced and the function of extremities improved significantly. Conclusion: Selective brachial plexus andlumber nerve roots rhizotomy is effective in reducing spasticity of the extrimities.

The progress in the treatment of spastic cerebral palsy with selective dorsal rhizotomy (SDR)

Spasticity is the main disabling clinical manifestation of children with cerebral palsy(CP).Selective dorsal rhizotomy(SDR)has been performed for the treatment of spastic CP in Asia for quite some time from 1990.The purpose of this review is to discuss the historical origin and development of SDR.Our goal here is to identify the current patient selection criteria for SDR and to point out indications and contraindications based on the patients with CP,age from 2 to 18 years-old,over 6000 cases,who received SDR surgery with spasticity of muscle tension more than 3 degrees in our center.We also discuss evidence-based approaches on how to evaluate postoperative patient outcomes of SDR and how complications can be avoided.Finally,we mention progress made in terms of SDR technical advances and how improvements can be made in the future.In conclusion,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.

Intraoperative neurophysiological monitoring in selective dorsal rhizotomy (SDR)

For decades,intraoperative neurophysiological monitoring(IONM)has been used to guide selective dorsal rhizotomy(SDR)for the treatment of spastic cerebral palsy(CP).Electromyography(EMG)interpretation methods,which are the core of IONM,have never been fully discussed and addressed,and their importance and necessity in SDR have been questioned for years.However,outcomes of CP patients who have undergone IONM-guided SDR have been favorable,and surgery-related complications are extremely minimal.In this paper,we review the history of evolving EMG interpretation methods as well as their neuroelectrophysiological basis.

Orthopedic treatment of the lower limbs in spastic paralysis

Spastic paralysis of the limb mainly results from the central lesion,in which spastic cerebral palsy is the common cause.Due to durative muscle spasm in spastic cerebral palsy,it is often accompanied by the formation of secondary musculoskeletal deformities,resulting in limb motor disability.Based on its pathogenesis,surgical treatment is currently applied:selective posterior rhizotomy(SPR)or orthopedic surgery.The primary purpose of early orthopedic surgery was simply to correct limb deformities,which usually led to the recurrence of deformity as a result of the presence of spasticity.With the application of SPR,high muscle tone was successfully relieved,but limb deformity was still present postoperatively.Therefore,this study aimed to elaborate on the management of orthopedic surgery,common deformities of the lower limb,and orthopedic operative methods;discuss the relationship between SPR and orthopedic procedure for limb deformity;and focus on the indications,timing of intervention,and postoperative outcome of different surgical methods.

Selective peripheral neurotomy (SPN) as a treatment strategy for spasticity

Spasticity can be caused by central nervous system dysfunction,such as cerebral palsy and stroke.The accepted pathogenesis of spasticity is that the muscles are in the state of uninhibited stretch reflex without enough control of central nervous system.So far,there is no ideal way about how to repair central nervous system.However,the uninhibited stretch reflex can be reduced,targeting the posterior root of the spinal cord and peripheral nerves innervating the limbs,which are called selective posterior rhizotomy(SPR)and selective peripheral neurotomy(SPN),respectively.SPN is indicated for focal or multifocal spasticity,which is well accepted due to its low invasiveness and ease of use.How does the operation work?What do we do before and during this operation?Is there any risk to the patients?Our review summarizes the mechanism,indications,preoperative assessments,techniques,and complications of SPN.We hope that the spastic patients,such as pediatric cerebral palsy patients and older stroke patients,will benefit from this surgery.

Comparison of different microsurgery methods for trigeminal neuralgia

Objective: To study the influence of different microsurgical methods on surgical outcomes and complications, and to improve the surgical outcomes for trigeminal neuralgia. Methods: The clinical data of 109 patients with trigeminal neuralgia, who were treated with microsurgery, were analyzed retrospectively. All patients were divided into 3 groups according to surgical modality: the trigeminal neuralgia decompression group(TND group, 19 patients), the TND and rhizotomy group(rhizotomy group,55 patients), and the TND and selective lesioning group(lesioning group, 35 patients).The mid-term and short-term effects of microsurgery, and the occurrences of complications, were compared between the 3 groups. Results: There were no statistical differences in the frequency of complications between the 3 groups(P > 0.05). Eighty-four patients were followed up for 6 to 33 months. The rate of pain disappearance was found to be 94.4% in the TND group, and 100% in both the rhizotomy and lesioning groups; thus, no significant differences were found between these 3 groups(P > 0.05). Additionally, 50% of the patients in the rhizotomy group and 3.6% of the patients in the lesioning group had facial numbness while no patients were affected with facial numbness in the TND group, and the differences between these 3 groups were significant(P < 0.05). Conclusions: Microsurgery is effective and safe for trigeminal neuralgia. The use of TND, in combination with selective lesioning, ensures therapeutic efficacy and improves the quality of life in postoperative patients.