title: Infra-Conus Single-Level Laminectomy for Selective Dorsal Rhizotomy: Technical Advance.
abstract: OBJECTIVE
  Selective dorsal rhizotomy for spastic cerebral palsy is an effective and well-validated surgical approach. Multiple techniques have been described in the past including multiple laminectomies and a single-level laminectomy at the level of the conus. There is considerable technical challenge involved with a single-level laminectomy approach.
  
  
  METHODS
  We report here a modification of the single-level laminectomy that selectively analyzes each individual nerve root with electromyography to separate dorsal and ventral nerve roots through comparison of stimulus responses.
  
  
  RESULTS
  In 18 children with cerebral palsy who underwent this operation there was a mean improvement in the Modified Ashworth Scale of 2.0 with no reported incidence of muscle weakness, sensory loss, or neurogenic bladder.
  
  
  CONCLUSIONS
  This approach allows for a modification of selective dorsal rhizotomy through a single-level laminectomy and tailors the selection of nerve root sectioning to the individual patient of interest while still maintaining its effectiveness.
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Wash., USA.
authors.forename: James
authors.initials: J
authors.lastname: Bales
authors.forename: Susan
authors.initials: S
authors.lastname: Apkon
authors.forename: Marisa
authors.initials: M
authors.lastname: Osorio
authors.forename: Gregory
authors.initials: G
authors.lastname: Kinney
authors.forename: R Aaron
authors.initials: RA
authors.lastname: Robison
authors.forename: Erin
authors.initials: E
authors.lastname: Hooper
authors.forename: Samuel
authors.initials: S
authors.lastname: Browd
mesh_terms: D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009128:Muscle Spasticity / Q000000981:diagnostic imaging / Q000601:surgery*; D019051:Rhizotomy / Q000295:instrumentation / Q000379:methods*