SELECTIVE LUMBOSACRAL DORSAL RHIZOTOMY IMMEDIATELY CAUDAL TO THE CONUS MEDULLARIS FOR CEREBRAL-PALSY SPASTICITY

WE DESCRIBE A variation of selective dorsal rhizotomy for spastic cere bral palsy that involves sectioning of the dorsal spinal roots immedia tely caudal to the conus medullaris. The operation entails an L1-L2 la minectomy, ultrasonographic localization of the conus medullaris, and partial deafferentation of the L1-S2 roots with electromyographic test ing under an operating microscope. In 66 children with cerebral palsy, the operation reduced spasticity in the lower extremity without compl ications, e.g., motor weakness, neurogenic bladder, and sensory loss. It offers several important advantages over alternative techniques.