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Related Experiment Videos

How selective is selective posterior rhizotomy?

A R Cohen1, H C Webster

  • 1Department of Neurosurgery, New England Medical Center, Boston, Massachusetts 02111.

Surgical Neurology
|April 1, 1991
PubMed
Summary
This summary is machine-generated.

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Selective posterior rhizotomy for spasticity lacks standardized monitoring. Current electrophysiological methods may not reliably identify normal versus abnormal nerve pathways, necessitating reevaluation.

Area of Science:

  • Neurosurgery
  • Neurology
  • Pediatric Surgery

Background:

  • Selective posterior rhizotomy (SPR) is an increasingly used surgical treatment for spasticity.
  • The procedure is not standardized across medical centers.
  • Intraoperative electrophysiological monitoring is commonly used to guide SPR.

Observation:

  • Most SPR procedures utilize direct dorsal rootlet stimulation with electromyographic (EMG) monitoring.
  • The value of current EMG monitoring techniques in SPR has not been critically evaluated.
  • Authors performed 22 SPR procedures for spastic cerebral palsy.

Findings:

  • No "normal" EMG responses were identified in spastic patients undergoing SPR using current criteria.
  • Dorsal rootlets were selected for division based on relative abnormality.

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  • A nonspastic patient exhibited EMG tracings suggestive of spasticity.

    • Implications:

    • Current electrophysiological monitoring criteria in SPR may be unreliable.
    • The findings challenge the established utility of intraoperative EMG monitoring in SPR.
    • Reevaluation of electrophysiological monitoring techniques for SPR is recommended.