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.

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.