Selective Dorsal Rhizotomy for Spasticity due to Upper Motor Neuron Lesions

Abstract

Selective dorsal rhizotomy is a neurosurgical technique developed to reduce spasticity and improve mobility in children with cerebral palsy (CP) and lower extremity spasticity. First described in 1908, early procedures were effective at reducing spasticity but were associated with significant morbidity. Technical advancements over the last two decades have reduced the invasiveness of the procedure, typically from a five-level laminoplasty to a single-level laminotomy at the conus. Indications of SDR are severe regional spasticity, ambulant or severely disabled child, age from 3- to 10-year old, and the contraindication is dystonic Cerebral Palsy. SDRs can be performed where the nerve root exits the intervertebral foramina via multi-level laminectomies, or at the level of the conus via a single-level laminectomy. Sindou developed a novel modality for performing lumbar-sacral DR, named keyhole interlaminar dorsal rhizotomy (KIDR).

SDR is a well-studied and effective therapy for lower-extremity spasticity resulting from CP and may be beneficial in other types of upper motor neuron disease. This procedure has not been systematically studied in contexts outside of CP. MS and TSCI are the most commonly reported non-CP diagnoses in patients who have undergone SDR. Patients with TBI, spastic hemiplegia, and age greater than 45 years have undergone SDR despite falling outside common inclusion criteria for surgery. Spasticity is considered now as one of the most worldwide distributed disabling condition in both adults and pediatrics. It remarkably affects the human and national resources. The anatomical and physiological consideration, clinical presentation and pathological mechanisms should be well known. The different assessment modalities including the electrophysiological techniques, the physical methods, spasticity rating scales and measures for disability are also crucial for those who work in this field. Although there’s no cure for CP, many of its symptoms