Microsurgical selective posterior rhizotomy in the dorsal root entry zone for treatment of limb spasticity

SPR in the DREZ, which was introduced in 1972 by the senior author on the bases of anatomical studies in humans, selectively interrupts the (lateral) nociceptive and the (central) myotatic fibers, while sparing the (medial) lemniscal fibers. In addition it enhances the inhibitory mechanisms of the Lissauer's tract and dorsal horn. The procedure was effective--with a follow-up ranging from 1 to 14 years--in 93% of the paraplegic patients with flexion-adduction postures (50 cases) or severe hyperextension (3 cases) and in 89% of the hemiplegic patients with irreducible flexion of the upper extremity (23 cases) or lower limb (5 cases).