Selective Dorsal Rhizotomy

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This procedure is offered to select patients with spasticity resulting primarily from cerebral palsy who may not be ideal candidates for other types of surgical intervention. The surgery is performed through a lumbar laminectomy which allows for exposure of the collection of nerve roots (cauda equina) emanating from the tip of the spinal cord (conus medullaris). These motor and sensory nerve roots innervate the lower extremities as well as allowing for continence of bowel and bladder. Neurophysiological monitoring and intra-operative EMG differentiate sensory from motor nerve roots. The surgeon then selectively cuts a proportion of the sensory nerve roots thereby diminishing a sensory-motor feedback loop which potentiates increased muscular tone and spasticity.

Frequently Asked Questions (FAQs) About Selective Dorsal Rhizotomy

Who is a candidate for selective dorsal rhizotomy?

Selective dorsal rhizotomy may be considered for carefully selected patients with significant spasticity, most commonly related to cerebral palsy. Candidacy depends on factors such as the pattern and severity of spasticity, mobility and functional goals, overall health, and response to other treatments.

How does selective dorsal rhizotomy reduce spasticity?

During selective dorsal rhizotomy, the surgeon identifies and selectively divides certain sensory nerve rootlets that contribute to abnormal muscle tightness. Neurophysiological monitoring helps identify the appropriate nerve fibers while protecting motor function. Reducing these abnormal nerve signals can decrease spasticity in the lower extremities.

What does selective dorsal rhizotomy treat?

Selective dorsal rhizotomy is used to reduce spasticity, particularly in the lower extremities, most commonly in patients with cerebral palsy. The goal is to reduce abnormal muscle tightness and improve movement and function in appropriately selected patients.

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