title: Selective dorsal rhizotomy for spastic diplegia secondary to stroke in an adult patient.
abstract: BACKGROUND
  Selective dorsal rhizotomy (SDR) is often recommended for children with spastic paraparesis and cerebral palsy. SDR reduces spasticity in the lower extremities for these children with spastic paraplegia. However, SDR is infrequently recommended for adults with spasticity. Spastic diplegia in adult patients can be due to stroke, brain or spinal cord injury from trauma, infection, toxic-metabolic disorders, and other causes. Although rarely considered, SDR is an option for adult patients with spastic diplegia as well.
  
  
  METHODS
  The authors describe a patient who underwent a SDR with a successful postoperative outcome. This man suffered a hypertensive and hemorrhagic stroke secondary to intravenous drug abuse at age 46. A SDR was performed after two failed intrathecal baclofen pump placements due to recurrent infections, likely resulting from his immunocompromised status. The patient underwent lumbar laminectomies and dorsal rhizotomies at levels L1-S1 bilaterally. Postoperatively, the patient's spasticity was significantly reduced. His Ashworth spasticity score decreased from 4/5 to 1/5, and the reduction in tone has been durable over 3 years.
  
  
  CONCLUSIONS
  SDR in older patients with spastic paraparesis may be considered as a treatment option.
authors.affiliation: Department of Neurosciences, Morristown Medical Center, Goryeb Children's Hospital, Morristown, New Jersey, USA.
authors.forename: Melissa Ann
authors.initials: MA
authors.lastname: Eppinger
authors.affiliation: Department of Neurosciences, Morristown Medical Center, Goryeb Children's Hospital, Morristown, New Jersey, USA.
authors.forename: Casey Melissa
authors.initials: CM
authors.lastname: Berman
authors.affiliation: Department of Neurosciences, Morristown Medical Center, Goryeb Children's Hospital, Morristown, New Jersey, USA.
authors.forename: Catherine Anne
authors.initials: CA
authors.lastname: Mazzola
keywords: Intrathecal baclofen; selective dorsal rhizotomy; spastic diplegia; spastic paraparesis; spastic paraplegia; spasticity