[Selective peripheral neurotomy and selective dorsal rhizotomy].

Area of Science:

• Neurosurgery
• Neurology
• Orthopedics

Context:

• Non-destructive neuromodulation is gaining traction, but ablative neurosurgical procedures are vital for managing severe spasticity.
• Focal spasticity, such as equinus foot, is managed with selective peripheral neurotomy (SPN).
• Diffuse spasticity in cerebral palsy children is effectively treated with selective dorsal rhizotomy (SDR).

Purpose:

• To review the role and indications of ablative neurosurgical procedures for spasticity management.
• To highlight the benefits and techniques of SPN for focal spasticity.
• To emphasize the effectiveness and optimal application of SDR for diffuse spasticity.

Summary:

• Selective peripheral neurotomy addresses focal spasticity with minimal invasiveness, targeting specific nerves for conditions like foot deformities and limb flexion issues.
• Selective dorsal rhizotomy is a well-established treatment for diffuse spasticity in pediatric cerebral palsy, with long-term effectiveness supported by studies.
• Minimizing complications and maximizing benefits in SDR requires less invasive techniques and intraoperative neurophysiologic assessment.

Impact:

• Surgical management of harmful spasticity is a significant and rewarding clinical practice.
• These ablative procedures should be considered standard in clinical neurosurgical practice.
• Advances in techniques and assessment enhance patient outcomes for spasticity treatment.