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Selective dorsal rhizotomy: an old treatment re-emerging
  1. Kristian Aquilina1,
  2. David Graham2,
  3. Neil Wimalasundera3
  1. 1Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
  2. 2Faculty of Medicine, University of Sydney, Sydney, Australia
  3. 3The Wolfson Neurodisability Service, Great Ormond Street Hospital for Children NHS Trust, London, UK
  1. Correspondence to Kristian Aquilina, Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK; Kristian.aquilina{at}gosh.nhs.uk

Abstract

Selective dorsal rhizotomy (SDR) is a neurosurgical technique developed to reduce spasticity and improve mobility in children with cerebral palsy (CP) and lower extremity spasticity. It involves the selective division of lumbosacral afferent (sensory) rootlets at the conus or at the intervertebral foramina under intraoperative neurophysiological guidance. 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. As practised today, SDR is an effective treatment for young patients with bilateral spastic CP who are rigorously selected for surgery and for whom realistic objectives are set. SDR has therefore re-emerged as a valuable management option for spastic CP. In this article, the authors review the single-level SDR technique and its role in the management of bilateral spastic CP, with particular emphasis on patient selection and outcomes.

  • Neurodisability
  • Neurosurgery
  • Cerebral palsy
  • selective dorsal rhizotomy
  • spasticity

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