Selective posterior rhizotomy for children with cerebral palsy: a 7-year experience.
Although selective posterior rhizotomy (SPR) was pioneered as early as 1913, only over the past decade has the procedure gained popular use for the treatment of spasticity in cerebral palsy. The medical knowledge base regarding this procedure is expanding, and surgical techniques continue to be revised. We present our 7 years of experience in treating spastic cerebral palsy using SPR. The aspects of preoperative evaluation used by the multidisciplinary team to determine candidacy are outlined. The surgical procedure is detailed with a particular emphasis on the role of intraoperative nerve root stimulation to aid in selection for rootlet sectioning. Historical nerve stimulation protocols are reviewed and compared to our findings over the years. The functional goals are discussed in the context of the postoperative evaluation and therapies. Specific outcome in relation to joint range of motion, self care tasks, and ambulation is reported. The paper outlines a concise overview of our experiences and will assist the clinician in defining a protocol and expectations for SPR.
Nishida
T
T
Department of Neurology, Northwestern University Medical School, Chicago, IL 60611, USA.
Thatcher
S W
SW
Marty
G R
GR
D000203:Activities of Daily Living / Q000145:classification; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery; D018482:Muscle, Skeletal / Q000294:innervation; D009460:Neurologic Examination; D010348:Patient Care Team; D011183:Postoperative Complications / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D019051:Rhizotomy / Q000379:methods*; D013126:Spinal Nerve Roots / Q000503:physiopathology; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology