Summary
After their experience of Foerster's operation and its technical modifications in 80 cases the authors report a new concept of analysis and treatment of spasticity in lower limbs.
Spasticity of the different muscle groups is classified either as “useful spasticity” or “handicapping spasticity”. The first has to be preserved, the second must be reduced.
In order to achieve this purpose a new technique is presented, based on operative sectorial identification of the posterior rootlets subserving the “handicapping spasticity” by electrophysiological stimulation, muscle testing, and B.M.G. studies.
The conus medullaris and cauda equina are exposed by T 11-L 1 laminectomy, performed in the lateral position. The clinical and E.M.G. evaluation of responses to stimulation enables the surgeon to establish a map of rootlet groups which are marked with coloured threads. Selective resection of “handicapping posterior rootlets” is then performed after several tests of the mapping. The rootlets subserving useful spasticity are carefully preserved.
Ten cases are reported, comprising five cases of cerebral palsy operated upon since 1974 and five cases of posttraumatic spastic paraplegia from the same period. Pre and postoperative findings are summarized.
The technical features of this procedure are discussed and compared with other surgical procedures. The problem of the rootlet reflex arch is considered in the light of the effects of stimulation of anterior and posterior rootlets at the same level.
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Balasubramanian, V., Kanaka, T. S., Ramanujam, P. B., Stereotaxic surgery for cerebral palsy. J. Neurosurg.40 (1974), 577–582.
Benassy, J., Metamerical topography of the cord and its roots. Paraplegia (Edinb.)8 (1970), 75–79.
Bischoff, W., Die longitudinal myelotomie. Zbl. Neurochir.11 (1951), 79.
Foerster, O., Über eine neue operative Methode der Behandlung spastischer Lähmungen mittels Resektion hinterer Rückenmarkswurzeln. Z. Orthop. chir.22 (1908), 203.
Gros, C., Ouaknine, G., Vlahovitch, B., Frerebeau, Ph., La radicotomie sélective postérieure dans le traitement neuro-chirurgical de l'hypertonie pyramidale. Neuro-Chirurgie13 (1967), 505–518.
Gros, C., Frerebeau, Ph., Kuhner, A., Perez-Dominguez, E., Privat, J. M., Technical modification in the Foerster operation. Selective posterior lumbar roots section. The results of 18 years of practice. International Congress of Neurosurgery, Tokyo, Oct. 1973.
Guidetti, B., Fraioli, B., Problèmes cliniques et possibilités neurochirurgicales actuels dans les syndromes dyscinétiques. Réunion commune de la Société allemande de neurochirurgie et de la Société française de neuro-chirurgie, AGADIR, 1974 (in press : Annales de Neurochirurgie).
Held, J. P., Pierrot-Deseilligny, E., Rééducation motrice des affections neurologiques. Paris: Baillère Ed. 1969.
Ouaknine, G., La radicotomie sélective postérieure dans le traitement de l'hypertonie pyramidale. Thèse méd. Montpellier 1965.
Privat, Ch., La radicotomie sélective postérieure dans le cadre de la rééducation fonctionelle de l'hypertonie. Mémoire Montpellier 1974.
Privat, Ch., Frerebeau, P., Privat, J. M., Gros, C., La radicotomie sélective postérieure dans le cadre de la rééducation fonctionnelle de l'hypertonie, Evolution de la notion de sélectivité. 3èmes entretiens de rééducation et de réadaptation fonctionelle; Montpellier, mars 1975 (in press).
Siegfried, J., Stereotaxic cerebellar surgery. Conf. Neurol.33 (1971), 350.
Sindou, M., Fischer, G., Goutelle, A., La radicellotomie postérieure sélective dans le traitement des spasticités. Rev. Neurol.130 (1974), 201–206.
Tardieu, G., Les réflexes segmentaires. Motoneurone alpha. Fuseau neuro-musculaire et son innervation, réflexe d'étirement et innervation réciproque. Les organes de Golgi. Feuillets de l'I.M.C., Ass. Nat. I.M.C., Ed. Paris 1971 (III A 1–23 p.).
Toczek, S. K., McCullough, D. C., Gargour, G. W.et al., Selective sacral rootlet rhizotomy for hypertonic neurogenic bladder. J. Neurosurg.42 (1975), 567–574.
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Privat, J.M., Benezech, J., Frerebeau, P. et al. Sectorial posterior rhizotomy, a new technique of surgical treatment for spasticity. Acta neurochir 35, 181–195 (1976). https://doi.org/10.1007/BF01405946
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DOI: https://doi.org/10.1007/BF01405946