title: Monosegmental laminoplasty for selective dorsal rhizotomy--operative technique and influence on the development of scoliosis in ambulatory children with cerebral palsy.
abstract: OBJECTIVE
  Selective dorsal rhizotomy (SDR) reduces spasticity in children with cerebral palsy (CP) and is performed either through a lumbosacral multilevel laminectomy or a single-level laminectomy at the medullary conus. Spinal interventions generally involve the risk of subsequent instability depending on the extent of structural weakening. Destabilizing spasticity in CP might further increase this risk for both options. Laminoplasty is frequently applied to reduce instability through anatomical restoration, although the unavoidable interruption of interspinous ligaments might be a reason for inconsistent results. We report on a novel technique of laminoplasty, achieving complete restoration of the dorsal column.
  
  
  METHODS
  One hundred sixteen ambulatory children with gross motor function classification scale (GMFCS) level I to III were submitted to SDR through a single-level approach. The lamina was reinserted with a previously unreported technique of laminoplasty. Osseous reintegration of the excised lamina was supposed, if its spinous process was located in place on late follow-up radiographs. Scoliosis was described via Cobb's angle.
  
  
  RESULTS
  At a mean follow-up of 33 months, radiographs were available from 72 children with a mean age at surgery of 7.2 years. Sixty-two out of the 72 reinserted laminae were supposed to be vital and reintegrated. Seven children developed a predominantly mild scoliosis. No association was found between development of scoliosis and GMFCS level or age.
  
  
  CONCLUSIONS
  This novel laminoplasty technique provides the least invasive approach for SDR. The incidence of scoliosis after this single-level approach is comparable to the natural history of ambulatory CP children.
authors.affiliation: Department of Pediatric Orthopedic Surgery and Neuroorthopedics, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany. julia.funk@charite.de.
authors.forename: Julia Franziska
authors.identifier: http://orcid.org/0000-0002-1695-2124
authors.initials: JF
authors.lastname: Funk
authors.affiliation: Section of Pediatric Neurosurgery, Department of Neurosurgery, University of Ulm, Eythstrasse 24, 89075, Ulm, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Haberl
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000379:methods*; D065406:Laminoplasty / Q000009:adverse effects / Q000379:methods*; D008297:Male; D019051:Rhizotomy / Q000009:adverse effects / Q000379:methods*; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D016896:Treatment Outcome
keywords: Gross motor function; Less invasive spine surgery; Spasticity management; Spinal deformity