Cauda Equina-Level Selective Dorsal Rhizotomy

There are many approaches to performing selective dorsal rhizotomy (SDR). The two most commonly performed approaches are the cauda equina approach, popularized by Warwick Peacock in 1980, and the conus medullaris approach, as used initially by Foerster and later Gros, and having its modern incarnation in the work of Tae Sun Park. Peacock changed from the traditional conus approach as he felt this approach led to unpredictable outcomes and bladder and bowel complications in some patients at the time. With the modern addition of intraoperative neurophysiology and further advances in the selection of patients for SDR, this technique of performing selective dorsal rhizotomy at the level of the cauda equina lives on with long-term data in support of its use. The author elaborates on the cauda equina approach to SDR in this chapter.