Limited (L4-S1, L5-S1) selective dorsal rhizotomy for reducing spasticity in cerebral palsy

Selective posterior rhizotomy is effective for relieving spasticity associa ted with cerebral palsy. In current techniques dorsal roots from L1/L2 to S 1/S2 are selectively divided. With transoperative electromyography (EMG) si gnificant sensory loss has been prevented, hut postoperative hypotonia foll owing excessive reduction of the fusimotor drive is still of concern for su rgeons and therapists. To decrease the volume of deafferentiated rootlets w e proposed a limited selective posterior rhizotomy (LPSR) that limits the e xtent of the surgery to three (L4-S1) or two (L5-S1) dorsal roots. We prese nt the results of two group of spastic children: group 1 (n = 59, 32 quadri plegic and 27 diplegic) who had a L4-S1 LPSR. and group 2 (n = 12) in whom L5 and S1 were selectively rhizotomized. Posture, passive movilization. ran ge of joint movement, and muscle tone in hip flexors, adductors, leg flexor s and plantar flexors were graded according to the method proposed by Sindo u and Jeanmonod. In all groups there was a significant reduction of the men tioned parameters (Friedman test p < 0.001) at 6, 12 and 18 months after su rgery. The preoperative and postoperative ability to ambulate was classifie d into five grades. In all groups there was a significant (chi(2) between p < 0.01 and p < 0.001) improvement in the quality of their gait. A third of the patients achieved some form of independent ambulation. Our results sug gest that extensive selective deafferentation of the lower limbs is not an absolute requisite for reducing muscle tone or achieving functional improve ment in spastic children.