Nerve rootlets to be sectioned for spasticity resolution in selective dorsal rhizotomy.

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Rehabilitation Medicine

Background:

• Selective dorsal rhizotomy (SDR) is a surgical procedure to treat spasticity.
• Current protocols often rely on palpable responses to intraoperative electrical stimulation for selecting nerve rootlets to section.
• This study evaluates an SDR protocol that avoids detailed electromyographic classifications.

Purpose of the Study:

• To confirm the efficacy of a selective dorsal rhizotomy (SDR) protocol.
• To validate the use of palpable responses for intraoperative nerve rootlet selection.
• To correlate intraoperative findings with preoperative spasticity and postoperative outcomes.

Main Methods:

• Thirty-six children with cerebral palsy underwent SDR using the specified protocol.
• Nerve rootlets were prioritized for sectioning based on palpable clonic or bilateral responses.
• Intraoperative monitoring results and sectioning amounts were analyzed against physical evaluations.

Main Results:

• Significant improvements were observed in passive range of motion and muscle tone in the lower extremities.
• The percentage of rootlets with abnormal responses correlated with preoperative spasticity in specific muscle groups.
• Greater improvement in muscle tone was associated with a larger amount of nerve roots sectioned, excluding hamstrings.

Conclusions:

• Palpable responses during SDR reliably reflect preoperative spasticity.
• The current protocol is effective, but should be reviewed to potentially increase sectioning of rootlets with hyperactive responses.
• Increased sectioning, particularly for severely affected muscles, may enhance spasticity resolution.