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Residual spasticity after selective posterior rhizotomy

N Morota1, R Abbott, M Kofler

  • 1Division of Pediatric Neurosurgery, New York University Medical Center, NY 10016, USA.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|March 1, 1995
PubMed
Summary

Selective posterior rhizotomy for spastic cerebral palsy is more effective when including S2 roots. Preserving S2 roots to protect pudendal nerve activity does not increase residual spasticity.

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Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Rehabilitation Medicine

Background:

  • The surgical technique for selective posterior rhizotomy in treating spastic cerebral palsy is debated.
  • Evaluating residual spasticity after surgery is crucial for validating techniques.

Purpose of the Study:

  • To correlate residual spasticity with the number of roots lesioned and abnormally responding roots left after selective posterior rhizotomy.
  • To validate the surgical technique for spastic cerebral palsy used in North American neurosurgical centers.

Main Methods:

  • One hundred nine children with spastic cerebral palsy underwent selective posterior rhizotomy.
  • Children were divided into three groups based on the extent of root testing and lesioning (L2-S1, L2-S2, or L2-S2 with S1-S3 mapping for pudendal nerve activity).

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  • Residual spasticity in the gastrocnemius was assessed 6 months post-surgery.

    • Main Results:

    • Group C (L2-S2 roots tested, S1-S3 mapping) showed significantly less residual spasticity (6%) compared to Group A (33%) and Group B (11%).
    • Preserving abnormally responding S2 roots to protect pudendal nerve activity did not significantly increase residual spasticity (P > 0.1).
    • Inclusion of S2 roots significantly decreased residual spasticity (P < 0.01).

    Conclusions:

    • Including S2 roots in selective posterior rhizotomy reduces residual spasticity in children with spastic cerebral palsy.
    • Selective posterior rhizotomy techniques can preserve pudendal nerve function without compromising spasticity reduction.