Abstract
Cerebral palsy is a disorder of movement and posture, which is caused by a central nervous system insult sustained during gestation or early childhood. Spastic cerebral palsy is the most common form of the disease.
Selective posterior rhizotomy is an effective type of surgical treatment of spasticity in patients with cerebral palsy that has been used in many centers over the last two decades. We introduced this operation in our department as a new method for the treatment of spasticity in the Czech Republic.
Among 14 patients indicated for selective posterior rhizotomy, 10 suffered the quadruplegic form of cerebral palsy. In this group of patients, we modified the indication criteria; the main purpose of surgery was to reduce disabling spasticity and painful spasms.
Selective posterior rhizotomy was the first choice of treatment in 4 patients in whom the orthopedic correction of deformities was planned. Osteoplastic laminotomy L2-L5 was undertaken in all patients.
Intraoperative EMG monitoring to identify rootlets with abnormal response was performed. The preoperative and postoperative numbers of spasms, passive range of joint movements, Ashworth scale, Peacock grade, and the level of functional independence were assessed.
No neurological deficit attributable to the surgical procedure was observed in any of our patients. Selective posterior rhizotomy significantly reduced clonus and the number of painful spasms in patients with the most severe form of spasticity.