Selective Posterior Rhizotomy(SPR) for Treatment of Spasticity in the Patient with Cerebral Palsy

Kim, Bo Ihl; Choi, Ha Young; Kim, Yun Hee; Lee, Jung Chung

Abstract

A selective posterior rhizotomy(SPR) was done for reducing spasticity in 18 patients with cerebral palsy. Based on a standard techniques developed by Fasano(Lumbar SPR) and Heimberger(Cervical SPR), we dissected L1-S1 dorsal rootlets through T12, L1 laminectomy in 10 patients and C5-C8 dorsal rootlets through C5-C7 laminectomy in 8 patients. All the rootlets from each root were electrically stimulated with bipolar electrodes(1 sec, 1-50 mV). The muscle responses were observed visually and recorded by intraoperative 8-channel electromyography. The rootlets showing abnormal motor responses visually and electromyopraphically were divided and cut. The Patients were accessed preoperatively and postoperatively in terms of clinical, functional, electrophysiological evaluations. Reduction of spasticity was observed in 9 patients in Lumbar SPR, and 5 patients cervical SPR. Recurrence was seen in 3 patients in Lumbar SPR, and 3 patients in cervical SPR. It was noticed that the reasons for the bad outcomes was due to improper division and selection of the rootlets which should be cut. These results was shown that SPR could be effective for treating spasticity in the patients of cerebral palsy and more selective section of the rootlets based on neurophysiologic monitoring during operation might maximize its effectiveness on SPR in the treatment of spasticity.