gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Selective dorsal lumbo-sacral rhizotomy for spasticity in children. Why should the mini-invasive approach be preferred?

Meeting Abstract

  • corresponding author S. Zeme - Division of Neurosurgery, Department of Neurosciences, University of Turin, Italy
  • C. Fronda - Division of Neurosurgery, Department of Neurosciences, University of Turin, Italy
  • S. Forgnone - Division of Neurosurgery, Department of Neurosciences, University of Turin, Italy
  • P. Panciani - Division of Neurosurgery, Department of Neurosciences, University of Turin, Italy
  • M. Lanotte - Division of Neurosurgery, Department of Neurosciences, University of Turin, Italy
  • A. Ducati - Division of Neurosurgery, Department of Neurosciences, University of Turin, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.12.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc124.shtml

Published: May 30, 2008

© 2008 Zeme et al.
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Outline

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Objective: Most of the Authors perform selective dorsal rhizotomy (SDR) at lumbo-sacral level through an intraforaminal approach. We always used the juxtamedullary approach. The aim of our study is to analyze the pros an contra of our choice.

Methods: We prospectively studied 28 spastic cerebral palsy patients. Age was 4–25 years (mean: 12.7). SDR was performed through a laminectomy of L1, eventually extended to the inferior half of T12 and/or superior half of L2. Lumbo-sacral posterior rootlets were stimulated in their juxtamedullary segments, where they are naturally separated each other and from the anterior rootlets. Results were evaluated (mean follow-up: 7.5 years) using the usual clinical criteria, poli-EMG, computerized gate analysis (in the last 16 cases), and spine X-rays.

Results: Reliable intraoperative electrophysiological responses were usually obtained with a very low threshold current (0.1–2 volts). Between 28% and 76% (mean: 52%) of the stimulated rootlets were cut. Spastic hypertonia of the lower limbs was markedly and definitely reduced in all cases (mean preoperative Ashworth score: 3.54; final post-operative Ashworth score: 1.42). Improvement of gate was noted in all pre-operatively ambulatory patients. Suprasegmentary effects were recorded in 73% of cases. Post-operative complications were limited to transient patchy hypoesthesia in 21% of cases. Opioid analgesia was never required for controlling post-operative pain, and early mobilization in the 3rd–5th day was usually possible. Mild anterolisthesis of L1 was documented in 2 cases.

Conclusions: Juxtamedullary selective posterior rhizotomy provides a less invasive approach. It should be preferred to the juxtaforaminal approach because it gives at least the same results, does not increase the risk of sphincters damage, greatly reduces post-operative pain, and probably allows to record more reliable muscular responses.