Selective posterior rhizotomy: evolution of theory and practice

Area of Science:

• Neurosurgery
• Pediatric Neurology
• Rehabilitation Medicine

Background:

• Spastic cerebral palsy (CP) is increasingly prevalent, particularly in premature infants.
• Selective posterior rhizotomy (SPR) is a neurosurgical intervention aimed at reducing spasticity in children with CP.
• While SPR has a long history, a revised technique introduced in 1981 has led to significant refinements.

Purpose of the Study:

• To review the neurophysiological and anatomical underpinnings of selective posterior rhizotomy.
• To examine the evolution of SPR techniques and their impact on cerebral palsy management.
• To highlight the ongoing scientific interest in spasticity and CP driven by SPR advancements.

Main Methods:

• Review of historical and current literature on selective posterior rhizotomy.
• Analysis of neurophysiological and anatomical principles guiding SPR development.
• Examination of the impact of refined SPR techniques on clinical practice and theory.

Main Results:

• Improved survival rates of premature infants have increased the prevalence of spastic cerebral palsy.
• Selective posterior rhizotomy has proven effective in reducing spasticity in pediatric CP patients.
• Refinements in SPR techniques since 1981 have significantly altered the approach to CP management.

Conclusions:

• Selective posterior rhizotomy remains a key neurosurgical option for managing spasticity in cerebral palsy.
• The ongoing evolution of SPR continues to stimulate research into the mechanisms of spasticity and CP.
• Advances in SPR have reshaped both the theoretical understanding and practical treatment of cerebral palsy.