Child's Nervous System

, Volume 23, Issue 9, pp 991–1002

Selective dorsal rhizotomies in the treatment of spasticity related to cerebral palsy

Special Annual Issue

Abstract

Rationale

Selective dorsal rhizotomy (SDR) is a surgical technique developed over the past decades to manage patients diagnosed with cerebral palsy suffering from spastic diplegia. It involves selectively lesioning sensory rootlets in an effort to maintain a balance between elimination of spasticity and preservation of function. Several recent long-term outcome studies have been published. In addition, shorter follow-up randomized controlled studies have compared the outcome of patients having undergone physiotherapy alone with those that received physiotherapy after selective dorsal rhizotomy.

Materials and methods

In this account, we will discuss the rationale and outcome after SDR. The outcome is addressed in terms of the gross motor function measurement scale (GMFM), degree of elimination of spasticity, strength enhancement, range of motion, fine motor skills, activity of daily living, spastic hip, necessity for postoperative orthopedic procedures, bladder and sphincteric function, and finally possible early or late complications associated with the procedure.

Conclusion

We conclude that SDR is a safe procedure, which offers durable and significant functional gains to properly selected children with spasticity related to cerebral palsy.

Keywords

Selective dorsal rhizotomy Cerebral palsy Spasticity Outcome Spastic hip Activities daily living (ADL) GMFM Complications 

References

  1. 1.
    Abbe R (1889) A contribution to surgery of the spine. Med Rec (NY) 35:149–152Google Scholar
  2. 2.
    Abbott R (1992) Complications with selective posterior rhizotomy. Pediatr Neurosurg 18:43–47PubMedGoogle Scholar
  3. 3.
    Abbott R, Johann-Murphy M, Shiminski-Maher T, Quartermain D, Forem SL, Gold JT, Epstein FJ (1993) Selective dorsal rhizotomy: outcome and complications in treating spastic cerebral palsy. Neurosurgery 33:851–857PubMedGoogle Scholar
  4. 4.
    Adams J, Cahan LD, Perry J, Beeler LM (1995) Foot contact pattern following selective dorsal rhizotomy. Pediatr Neurosurg 23:76–81PubMedGoogle Scholar
  5. 5.
    Albright AL, Barry MJ, Fasick MP, Janosky J (1995) Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity. Pediatr Neurosurg 23:82–85PubMedGoogle Scholar
  6. 6.
    Arens LJ, Peacock WJ, Peter J (1989) Selective posterior rhizotomy: a long-term follow-up study. Child’s Nerv Syst 5:148–152Google Scholar
  7. 7.
    Bader D, Ramos AD, Lew CD, Platzker AC, Stabile MW, Keens TG (1987) Childhood sequelae of infant lung disease: exercise and pulmonary function abnormalities after bronchopulmonary dysplasia. J Pediatr 110:693–699PubMedGoogle Scholar
  8. 8.
    Beck AJ, Gaskill SJ, Marlin AE (1993) Improvement in upper extremity function and trunk control after selective posterior rhizotomy. Am J Occup Ther 47:704–707PubMedGoogle Scholar
  9. 9.
    Bennet WH (1889) A case in which acute spasmodic pain in the left lower extremity was completely relieved by subsural division of the posterior rootlets of certain spinal nerves. Med Chir Trans 72:329–348Google Scholar
  10. 10.
    Berman B, Vaughan CL, Peacock WJ (1990) The effect of rhizotomy on movement in patients with cerebral palsy. Am J Occup Ther 44:511–516PubMedGoogle Scholar
  11. 11.
    Bjornson KF, McLaughlin JF (2001) The measurement of health-related quality of life (HRQL) in children with cerebral palsy. Eur J Neurol 8(Suppl 5):183–193PubMedGoogle Scholar
  12. 12.
    Bloom KK, Nazar GB (1994) Functional assessment following selective posterior rhizotomy in spastic cerebral palsy. Child’s Nerv Syst 10:84–86Google Scholar
  13. 13.
    Boscarino LF, Ounpuu S, Davis RB III, Gage JR, DeLuca PA (1993) Effects of selective dorsal rhizotomy on gait in children with cerebral palsy. J Pediatr Orthop 13:174–179PubMedGoogle Scholar
  14. 14.
    Buckon CE, Sienko TS, Aiona MD, Piatt JH (1996) Assessment of upper-extremity function in children with spastic diplegia before and after selective dorsal rhizotomy. Dev Med Child Neurol 38:967–975PubMedCrossRefGoogle Scholar
  15. 15.
    Buckon CE, Thomas SS, Piatt JH Jr, Aiona MD, Sussman MD (2004) Selective dorsal rhizotomy versus orthopedic surgery: a multidimensional assessment of outcome efficacy. Arch Phys Med Rehabil 85:457–465PubMedGoogle Scholar
  16. 16.
    Cahan LD, Adams JM, Perry J, Beeler LM (1990) Instrumented gait analysis after selective dorsal rhizotomy. Dev Med Child Neurol 32:1037–1043PubMedCrossRefGoogle Scholar
  17. 17.
    Chabal C, Jacobson L, Little J (1988) Effects of intrathecal fentanyl and lidocaine on somatosensory-evoked potentials, the H-reflex, and clinical responses. Anesth Analg 67:509–513PubMedGoogle Scholar
  18. 18.
    Chicoine MR, Park TS, Kaufman BA (1997) Selective dorsal rhizotomy and rates of orthopedic surgery in children with spastic cerebral palsy. J Neurosurg 86:34–39PubMedGoogle Scholar
  19. 19.
    Cohen AR, Webster HC (1991) How selective is selective posterior rhizotomy? Surg Neurol 35:267–272PubMedGoogle Scholar
  20. 20.
    Crichton JU, Mackinnon M, White CP (1995) The life-expectancy of persons with cerebral palsy. Dev Med Child Neurol 37:567–576PubMedGoogle Scholar
  21. 21.
    Deletis V, Vodusek DB, Abbott R, Epstein FJ, Turndorf H (1992) Intraoperative monitoring of the dorsal sacral roots: minimizing the risk of iatrogenic micturition disorders. Neurosurgery 30:72–75PubMedGoogle Scholar
  22. 22.
    du Plessis AJ, Volpe JJ (2002) Perinatal brain injury in the preterm and term newborn. Curr Opin Neurol 15:151–157PubMedGoogle Scholar
  23. 23.
    Dudgeon BJ, Libby AK, McLaughlin JF, Hays RM, Bjornson KF, Roberts TS (1994) Prospective measurement of functional changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 75:46–53PubMedGoogle Scholar
  24. 24.
    Engsberg JR, Olree KS, Ross SA, Park TS (1998) Spasticity and strength changes as a function of selective dorsal rhizotomy. J Neurosurg 88:1020–1026PubMedGoogle Scholar
  25. 25.
    Engsberg JR, Ross SA, Collins DR, Park TS (2006) Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy. J Neurosurg 105:8–15PubMedGoogle Scholar
  26. 26.
    Evans PM, Evans SJ, Alberman E (1990) Cerebral palsy: why we must plan for survival. Arch Dis Child 65:1329–1333PubMedGoogle Scholar
  27. 27.
    Farmer JP, Mittal S (2005) Baclofen. In: Baltuch GH (ed) Surgical management of movement disorders. Taylor & Francis, Roca Raton, FLGoogle Scholar
  28. 28.
    Farmer JP, Mittal S (2005) Cerebral palsy. In: Baltuch GH (ed) Surgical management of movement disorders. Taylor & Francis, Roca Raton, FL, pp 245–256Google Scholar
  29. 29.
    Fasano VA, Barolat-Romana G, Ivaldi A, Sguazzi A (1976) Functional posterior radiculotomy, in the treatment of cerebral spasticity. Preoperative electric stimulation of posterior roots and its use in the choice of the roots to be sectioned. Neurochirurgie 22:23–34PubMedGoogle Scholar
  30. 30.
    Fasano VA, Broggi G, Zeme S (1988) Intraoperative electrical stimulation for functional posterior rhizotomy. Scand J Rehabil Med Suppl 17:149–154PubMedGoogle Scholar
  31. 31.
    Fasano VA, Broggi G, Zeme S, Lo RG, Sguazzi A (1980) Long-term results of posterior functional rhizotomy. Acta Neurochir Suppl (Wien) 30:435–439Google Scholar
  32. 32.
    Foerster O (1913) On the indications and results of the excision of posterior spinal nerve roots in men. Surg Gynecol Obstet 16:463–474Google Scholar
  33. 33.
    Folio MR, Fewell RR (2000) Peabody developmental motor scales. PRO-ED, Austin, TXGoogle Scholar
  34. 34.
    Fukuhara T, Najm IM, Levin KH, Luciano MG, Brant MSC (2000) Nerve rootlets to be sectioned for spasticity resolution in selective dorsal rhizotomy. Surg Neurol 54:126–132PubMedGoogle Scholar
  35. 35.
    Gros C, Ouaknine G, Vlahovitch B, Frerebeau P (1967) Selective posterior radicotomy in the neurosurgical treatment of pyramidal hypertension. Neurochirurgie 13:505–518PubMedGoogle Scholar
  36. 36.
    Grossi P, Arner S (1984) Effect of epidural morphine on the Hoffman-reflex in man. Acta Anaesthesiol Scand 28:152–154PubMedGoogle Scholar
  37. 37.
    Gul SM, Steinbok P, McLeod K (1999) Long-term outcome after selective posterior rhizotomy in children with spastic cerebral palsy. Pediatr Neurosurg 31:84–95PubMedGoogle Scholar
  38. 38.
    Heim RC, Park TS, Vogler GP, Kaufman BA, Noetzel MJ, Ortman MR (1995) Changes in hip migration after selective dorsal rhizotomy for spastic quadriplegia in cerebral palsy. J Neurosurg 82:567–571PubMedGoogle Scholar
  39. 39.
    Hodgkinson I, Berard C, Jindrich ML, Sindou M, Mertens P, Berard J (1997) Selective dorsal rhizotomy in children with cerebral palsy. Results in 18 cases at one year postoperatively. Stereotact Funct Neurosurg 69:259–267PubMedGoogle Scholar
  40. 40.
    Houle AM, Vernet O, Jednak R, Pippi Salle JL, Farmer JP (1998) Bladder function before and after selective dorsal rhizotomy in children with cerebral palsy. J Urol 160:1088–1091PubMedGoogle Scholar
  41. 41.
    Huang JC, Deletis V, Vodusek DB, Abbott R (1997) Preservation of pudendal afferents in sacral rhizotomies. Neurosurgery 41:411–415PubMedGoogle Scholar
  42. 42.
    Hutton JL, Pharoah PO (2002) Effects of cognitive, motor, and sensory disabilities on survival in cerebral palsy. Arch Dis Child 86:84–89PubMedGoogle Scholar
  43. 43.
    Kinghorn J (1992) Upper extremity functional changes following selective posterior rhizotomy in children with cerebral palsy. Am J Occup Ther 46:502–507PubMedGoogle Scholar
  44. 44.
    Kuban KC, Leviton A (1994) Cerebral palsy. N Engl J Med 330:188–195PubMedGoogle Scholar
  45. 45.
    Lang FF, Deletis V, Cohen HW, Velasquez L, Abbott R (1994) Inclusion of the S2 dorsal rootlets in functional posterior rhizotomy for spasticity in children with cerebral palsy. Neurosurgery 34:847–853PubMedGoogle Scholar
  46. 46.
    Lazareff JA, Garcia-Mendez MA, De RR, Olmstead C (1999) Limited (L4–S1, L5–S1) selective dorsal rhizotomy for reducing spasticity in cerebral palsy. Acta Neurochir (Wien) 141:743–751Google Scholar
  47. 47.
    Lazareff JA, Mata-Acosta AM, Garcia-Mendez MA (1990) Limited selective posterior rhizotomy for the treatment of spasticity secondary to infantile cerebral palsy: a preliminary report. Neurosurgery 27:535–538PubMedGoogle Scholar
  48. 48.
    Lewin JE, Mix CM, Gaebler-Spira D (1993) Self-help and upper extremity changes in 36 children with cerebral palsy subsequent to selective posterior rhizotomy and intensive occupational and physical therapy. Phys Occup Ther Pediatr 13:25–42Google Scholar
  49. 49.
    Loewen P, Steinbok P, Holsti L, MacKay M (1998) Upper extremity performance and self-care skill changes in children with spastic cerebral palsy following selective posterior rhizotomy. Pediatr Neurosurg 29:191–198PubMedGoogle Scholar
  50. 50.
    Logigian EL, Shefner JM, Goumnerova L, Scott RM, Soriano SG, Madsen J (1996) The critical importance of stimulus intensity in intraoperative monitoring for partial dorsal rhizotomy. Muscle Nerve 19:415–422PubMedGoogle Scholar
  51. 51.
    Marbini A, Ferrari A, Cioni G, Bellanova MF, Fusco C, Gemignani F (2002) Immunohistochemical study of muscle biopsy in children with cerebral palsy. Brain Dev 24:63–66PubMedGoogle Scholar
  52. 52.
    Marty GR, Dias LS, Gaebler-Spira D (1995) Selective posterior rhizotomy and soft-tissue procedures for the treatment of cerebral diplegia. J Bone Joint Surg Am 77:713–718PubMedGoogle Scholar
  53. 53.
    McLaughlin JF, Bjornson K, Temkin N, Steinbok P, Wright FV, Reiner A, Roberts TS, Drake JM, O’Donnel MD, Rosenbaum PL, Barber J, Farrel A (2002) Selective dorsal rhizotomy: meta-analysis of the three randomized controlled trials. Dev Med Child Neurol 44:17–25PubMedGoogle Scholar
  54. 54.
    McLaughlin JF, Bjornson KF, Astley SJ, Graubert C, Hays RM, Roberts TS, Price R, Temkin N (1998) Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40:220–232PubMedCrossRefGoogle Scholar
  55. 55.
    McLaughlin JF, Bjornson KF, Astley SJ, Hays RM, Hoffinger SA, Armantrout EA, Roberts TS (1994) The role of selective dorsal rhizotomy in cerebral palsy: critical evaluation of a prospective clinical series. Dev Med Child Neurol 36:755–769PubMedCrossRefGoogle Scholar
  56. 56.
    McNeal DM, Hawtrey CE, Wolraich ML, Mapel JR (1983) Symptomatic neurogenic bladder in a cerebral-palsied population. Dev Med Child Neurol 25:612–616PubMedCrossRefGoogle Scholar
  57. 57.
    Mittal S, Farmer JP, Al-Atassi B, Gibis J, Kennedy E, Galli C, Courchesnes G, Poulin C, Cantin MA, Benaroch TE (2002) Long-term functional outcome after selective posterior rhizotomy. J Neurosurg 97:315–325PubMedGoogle Scholar
  58. 58.
    Mittal S, Farmer JP, Al-Atassi B, Montpetit K, Gervais N, Poulin C, Benaroch TE, Cantin MA (2002) Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure. J Neurosurg 97:510–518PubMedGoogle Scholar
  59. 59.
    Mittal S, Farmer JP, Al-Atassi B, Montpetit K, Gervais N, Poulin C, Cantin MA, Benaroch TE (2002) Impact of selective posterior rhizotomy on fine motor skills. Long-term results using a validated evaluative measure. Pediatr Neurosurg 36:133–141PubMedGoogle Scholar
  60. 60.
    Mittal S, Farmer JP, Poulin C, Silver K (2001) Reliability of intraoperative electrophysiological monitoring in selective posterior rhizotomy. J Neurosurg 95:67–75PubMedGoogle Scholar
  61. 61.
    Montgomery PC (1992) A clinical report of long term outcomes following selective posterior rhizotomy: implications for selection, follow-up, and research. Phys Occup Ther Pediatr 12:67–87Google Scholar
  62. 62.
    Murphy KP, Molnar GE, Lankasky K (1995) Medical and functional status of adults with cerebral palsy. Dev Med Child Neurol 37:1075–1084PubMedCrossRefGoogle Scholar
  63. 63.
    Murphy N, Such-Neibar T (2003) Cerebral palsy diagnosis and management: the state of the art. Curr Probl Pediatr Adolesc Health Care 33:146–169PubMedGoogle Scholar
  64. 64.
    Nishida T, Thatcher SW, Marty GR (1995) Selective posterior rhizotomy for children with cerebral palsy: a 7-year experience. Child’s Nerv Syst 11:374–380Google Scholar
  65. 65.
    Nordmark E, Jarnlo GB, Hagglund G (2000) Comparison of the gross motor function measure and paediatric evaluation of disability inventory in assessing motor function in children undergoing selective dorsal rhizotomy. Dev Med Child Neurol 42:245–252PubMedGoogle Scholar
  66. 66.
    O’Brien DF, Park TS (2006) A review of orthopedic surgeries after selective dorsal rhizotomy. Neurosurg Focus 21:e2PubMedGoogle Scholar
  67. 67.
    O’Brien DF, Park TS, Puglisi JA, Collins DR, Leuthardt EC (2004) Effect of selective dorsal rhizotomy on need for orthopedic surgery for spastic quadriplegic cerebral palsy: long-term outcome analysis in relation to age. J Neurosurg 101:59–63PubMedGoogle Scholar
  68. 68.
    O’Brien DF, Park TS, Puglisi JA, Collins DR, Leuthardt EC, Leonard JR (2005) Orthopedic surgery after selective dorsal rhizotomy for spastic diplegia in relation to ambulatory status and age. J Neurosurg 103:5–9PubMedGoogle Scholar
  69. 69.
    Park TS (1994) Selective dorsal rhizotomy for the spasticity of cerebral palsy. In: Rengachary SS, Wilkins RH (eds) Neurosurgical operative atlas. American Association of Neurological Surgeons, Park Ridge, IL, pp 183–190Google Scholar
  70. 70.
    Park TS, Johnston JM (2006) Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Technical note. Neurosurg Focus 21:e7PubMedGoogle Scholar
  71. 71.
    Park TS, Vogler GP, Phillips LH, Kaufman BA, Ortman MR, McClure SM, Gaffney PE (1994) Effects of selective dorsal rhizotomy for spastic diplegia on hip migration in cerebral palsy. Pediatr Neurosurg 20:43–49PubMedGoogle Scholar
  72. 72.
    Peacock WJ, Arens LJ (1982) Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J 62:119–124PubMedGoogle Scholar
  73. 73.
    Peacock WJ, Arens LJ, Berman B (1987) Cerebral palsy spasticity. Selective posterior rhizotomy. Pediatr Neurosci 13:61–66PubMedGoogle Scholar
  74. 74.
    Peacock WJ, Staudt LA (1991) Functional outcomes following selective posterior rhizotomy in children with cerebral palsy. J Neurosurg 74:380–385PubMedCrossRefGoogle Scholar
  75. 75.
    Peter JC, Arens LJ (1993) Selective posterior lumbosacral rhizotomy for the management of cerebral palsy spasticity. A 10-year experience. S Afr Med J 83:745–747PubMedGoogle Scholar
  76. 76.
    Phillips LH, Park TS (1991) Electrophysiologic mapping of the segmental anatomy of the muscles of the lower extremity. Muscle Nerve 14:1213–1218PubMedGoogle Scholar
  77. 77.
    Reid CJ, Borzyskowski M (1993) Lower urinary tract dysfunction in cerebral palsy. Arch Dis Child 68:739–742PubMedGoogle Scholar
  78. 78.
    Rumeau-Rouquette C, Grandjean H, Cans C, du MC, Verrier A (1997) Prevalence and time trends of disabilities in school-age children. Int J Epidemiol 26:137–145PubMedGoogle Scholar
  79. 79.
    Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S (1989) The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 31:341–352PubMedCrossRefGoogle Scholar
  80. 80.
    Sacco DJ, Tylkowski CM, Warf BC (2000) Nonselective partial dorsal rhizotomy: a clinical experience with 1-year follow-up. Pediatr Neurosurg 32:114–118PubMedGoogle Scholar
  81. 81.
    Saito N, Ebara S, Ohotsuka K, Kumeta H, Takaoka K (1998) Natural history of scoliosis in spastic cerebral palsy. Lancet 351:1687–1692PubMedGoogle Scholar
  82. 82.
    Schijman E, Erro MG, Meana NV (1993) Selective posterior rhizotomy: experience of 30 cases. Child’s Nerv Syst 9:474–477Google Scholar
  83. 83.
    Smyth MD, Peacock WJ (2000) The surgical treatment of spasticity. Muscle Nerve 23:153–163PubMedGoogle Scholar
  84. 84.
    Staudt LA, Nuwer MR, Peacock WJ (1995) Intraoperative monitoring during selective posterior rhizotomy: technique and patient outcome. Electroencephalogr Clin Neurophysiol 97:296–309PubMedGoogle Scholar
  85. 85.
    Steinbok P, Gustavsson B, Kestle JR, Reiner A, Cochrane DD (1995) Relationship of intraoperative electrophysiological criteria to outcome after selective functional posterior rhizotomy. J Neurosurg 83:18–26PubMedGoogle Scholar
  86. 86.
    Steinbok P, Hicdonmez T, Sawatzky B, Beauchamp R, Wickenheiser D (2005) Spinal deformities after selective dorsal rhizotomy for spastic cerebral palsy. J Neurosurg 102:363–373PubMedGoogle Scholar
  87. 87.
    Steinbok P, Kestle JR (1996) Variation between centers in electrophysiologic techniques used in lumbosacral selective dorsal rhizotomy for spastic cerebral palsy. Pediatr Neurosurg 25:233–239PubMedGoogle Scholar
  88. 88.
    Steinbok P, Langill L, Cochrane DD, Keyes R (1992) Observations on electrical stimulation of lumbosacral nerve roots in children with and without lower limb spasticity. Child’s Nerv Syst 8:376–382Google Scholar
  89. 89.
    Steinbok P, Reiner A, Beauchamp RD, Cochrane DD, Keyes R (1992) Selective functional posterior rhizotomy for treatment of spastic cerebral palsy in children. Review of 50 consecutive cases. Pediatr Neurosurg 18:34–42PubMedGoogle Scholar
  90. 90.
    Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, Kestle J (1997) A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39:178–184PubMedCrossRefGoogle Scholar
  91. 91.
    Steinbok P, Schrag C (1998) Complications after selective posterior rhizotomy for spasticity in children with cerebral palsy. Pediatr Neurosurg 28:300–313PubMedGoogle Scholar
  92. 92.
    Storrs BB, Nishida T (1988) Use of the ‘H’ reflex recovery curve in selective posterior rhizotomy. Pediatr Neurosci 14:120–123PubMedGoogle Scholar
  93. 93.
    Subramanian N, Vaughan CL, Peter JC, Arens LJ (1998) Gait before and 10 years after rhizotomy in children with cerebral palsy spasticity. J Neurosurg 88:1014–1019PubMedGoogle Scholar
  94. 94.
    Swaminathan S, Quinn J, Stabile MW, Bader D, Platzker AC, Keens TG (1989) Long-term pulmonary sequelae of meconium aspiration syndrome. J Pediatr 114:356–361PubMedGoogle Scholar
  95. 95.
    Sweetser PM, Badell A, Schneider S, Badlani GH (1995) Effects of sacral dorsal rhizotomy on bladder function in patients with spastic cerebral palsy. Neurourol Urodyn 14:57–64PubMedGoogle Scholar
  96. 96.
    Thomas SS, Aiona MD, Pierce R, Piatt JH (1996) Gait changes in children with spastic diplegia after selective dorsal rhizotomy. J Pediatr Orthop 16:747–752PubMedGoogle Scholar
  97. 97.
    Van de Wiele BM, Staudt LA, Rubinstien EH, Nuwer M, Peacock WJ (1996) Perioperative complications in children undergoing selective posterior rhizotomy: a review of 105 cases. Paediatr Anaesth 6:479–486PubMedGoogle Scholar
  98. 98.
    Vaughan CL, Berman B, Staudt LA, Peacock WJ (1988) Gait analysis of cerebral palsy children before and after rhizotomy. Pediatr Neurosci 14:297–300PubMedCrossRefGoogle Scholar
  99. 99.
    von Koch CS, Park TS, Steinbok P, Smyth M, Peacock WJ (2001) Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity. Pediatr Neurosurg 35:57–65Google Scholar
  100. 100.
    Warf BC, Nelson KR (1996) The electromyographic responses to dorsal rootlet stimulation during partial dorsal rhizotomy are inconsistent. Pediatr Neurosurg 25:13–19PubMedGoogle Scholar
  101. 101.
    Weiss IP, Schiff SJ (1993) Reflex variability in selective dorsal rhizotomy. J Neurosurg 79:346–353PubMedGoogle Scholar
  102. 102.
    Wong AM, Chen CL, Hong WH, Tang FT, Lui TN, Chou SW (2000) Motor control assessment for rhizotomy in cerebral palsy. Am J Phys Med Rehabil 79:441–450PubMedGoogle Scholar
  103. 103.
    Wright FV, Sheil EM, Drake JM, Wedge JH, Naumann S (1998) Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 40:239–247PubMedCrossRefGoogle Scholar
  104. 104.
    Yang TF, Chan RC, Wong TT, Bair WN, Kao CC, Chuang TY, Hsu TC (1996) Quantitative measurement of improvement in sitting balance in children with spastic cerebral palsy after selective posterior rhizotomy. Am J Phys Med Rehabil 75:348–352PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.The Montreal Children’s HospitalMcGill University Health CenterMontrealCanada
  2. 2.Department of Pediatric SurgeryMcGill University Health CenterMontrealCanada
  3. 3.McGill UniversityMontrealCanada

Personalised recommendations