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Ira P. Weiss and Steven J. Schiff

led to a dramatic resurgence of selective dorsal rhizotomy. 3, 15 This trend rests on observations by Fasano, et al. 8 in 1978 that portions of each dorsal root could be selected for section using electrical stimulation. Fasano's criteria were adopted by Peacock and colleagues, 16, 17 who performed this procedure at the level of the cauda equina in the lumbar region. In a series of reports published over the past decade, Peacock and co-workers 4, 19, 31 demonstrated substantial improvements in ambulation in such patients. Fasano, et al. , 7 rarely sectioned

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Arnold D. C. Rivera, Tim Burke, Steven J. Schiff and Ira P. Weiss

S ensory rhizotomy for spasticity is among the oldest neurosurgical operations. 6 Over the past decade, the application of sophisticated electrophysiological monitoring has helped to foster the resurgence in popularity of this technique in the form of selective dorsal rhizotomy. 1, 12 Such monitoring increases the intraoperative time and cost of this surgery. Using empirical intraoperative observations, 4, 5 criteria have been developed to differentiate and choose normal from abnormal dorsal rootlets for selective sectioning. Rootlets are thus considered

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Nebras M. Warsi, Jignesh Tailor, Ian C. Coulter, Husain Shakil, Adriana Workewych, Renée Haldenby, Sara Breitbart, Samuel Strantzas, Michael Vandenberk, Michael C. Dewan and George M. Ibrahim

Briefly, a literature search was performed on August 20, 2019, using the keywords “cerebral palsy,” “rhizotomy,” and/or “selective dorsal rhizotomy” in combination. The databases searched included Ovid MEDLINE, Embase, and PubMed with no search restrictions. Title, abstract, and full-text review were conducted by two independent authors (N.M.W., M.C.D.). Disagreements were resolved with discussion and re-review. All final studies included described a novel surgical technique not previously published. Data Synthesis Data pertaining to operative technique—with a

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Paul Steinbok, Tufan Hicdonmez, Bonita Sawatzky, Richard Beauchamp and Diane Wickenheiser

. Operative Procedure Selective dorsal rhizotomy was performed via multilevel laminectomies or laminoplasties, usually from L-1 to S-1. Partial rhizotomies of bilateral dorsal roots were generally performed from L-2 to S-2. The percentage of the dorsal roots cut at any level varied from 20 to 90, with a trend over the years of cutting smaller percentages of the roots and less of S-2 and L-4. The basis for selection of the dorsal nerve rootlets to be cut evolved over time. Initially, selection was based almost solely on electrophysiological responses to intraoperative

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William C. Gump, Ian S. Mutchnick and Thomas M. Moriarty

intrathecal baclofen pump, which was removed 2 weeks later due to infection, although caregiver satisfaction with this treatment modality was described as minimal. Selective dorsal rhizotomy was subsequently performed, which resulted in the disappearance of leg spasticity. The postoperative course was complicated by a urinary tract infection, recurrent migrating arthritis, and ventral dislocation of the L-1 spinous process requiring surgical revision. Over the next 3 years, the clinical course remained progressive, although spasticity never returned in the legs. A second

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Jeffrey G. Ojemann, T. S. Park, Robert Komanetsky, Richard A. A. Day and Bruce A. Kaufman

C erebral palsy (CP) is a disorder of motor function caused by perinatal insults to cerebral motor centers. The resulting spasticity often affects the lower extremities preferentially. Dorsal rhizotomy, as performed by Foerster, 5 offers relief from spasticity by ablation of dorsal roots in the lumbosacral region. Modifications by Fasano, et al., 4 permit selective dorsal rhizotomy, sectioning rootlets based on intraoperative stimulation of dorsal roots. The effects of selective dorsal rhizotomy on spastic diplegia and spastic gait are well described. 25

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Donncha F. O'Brien, Tae-Sung Park, Joan A. Puglisi, David R. Collins, Eric C. Leuthardt and Jeffrey R. Leonard

for financial assistance received from the Royal College of Surgeons in Ireland, which enabled him to travel to St. Louis Children's Hospital. Abbreviations used in this paper CP = cerebral palsy ; N-CAM = nerve cell adhesion molecule ; SDR = selective dorsal rhizotomy . References 1. Arens LJ , Peacock WJ , Peter J : Selective posterior rhizotomy: a long-term follow-up study. Childs Nerv Syst 5 : 148 – 152 , 1989 Arens LJ, Peacock WJ, Peter J: Selective posterior rhizotomy: a

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Roy W. R. Dudley, Michele Parolin, Bruno Gagnon, Rajeet Saluja, Rita Yap, Kathleen Montpetit, Joanne Ruck, Chantal Poulin, Marie-Andrée Cantin, Thierry E. Benaroch and Jean-Pierre Farmer

more severely affected children (GMFCS Groups III, IV, and V) actually declines through adolescence and into early adulthood. 10 Selective dorsal rhizotomy is a well-established treatment for carefully selected children with the spastic form of CP. 7 Two of 3 randomized control trials and a metaanalysis of those trials have revealed the functional benefits of SDR, at least up to 2 years after surgery. 12–14 , 16 , 20 , 23 However, no study has reported long-term data on large numbers of patients using standardized functional assessment tools; thus it remains

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Ludovic P. Pao, Liang Zhu, Sarah Tariq, Christine A. Hill, Bangning Yu, Mariana Kendrick, Magdalena Jungman, Emilie L. Miesner, Surya N. Mundluru, Stacey L. Hall, Glendaliz Bosques, Nivedita Thakur and Manish N. Shah

activities of daily living. 2 , 7 However, spasticity often prevents patients from participating or progressing in therapy. 6 , 31 Neurosurgical treatments to reduce spasticity include intrathecal baclofen pump insertion and selective dorsal rhizotomy (SDR). 5 , 10 , 15 , 22 , 24 , 28 , 32 Single-level SDR inhibits the patient’s pathologically hyperactive stretch reflex by severing 75% of dorsal nerve roots around the conus of the spinal cord, leading to the immediate cessation of spasticity with excellent 2- to 3-decade long-term outcomes. 26 , 27 SDR, when performed

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Jeff Dror Golan, Jeffery Alan Hall, Gus O'Gorman, Chantal Poulin, Thierry Ezer Benaroch, Marie-Andrée Cantin and Jean-Pierre Farmer

it would otherwise assume to maintain sagittal balance in the erect position. Selective dorsal rhizotomy may be more protective in the development of hyperlordosis when it is conducted early enough to prevent hip-flexion contractures in ambulatory patients. Alternatively, in older children, performing an L-1 nerve root rhizotomy by extending the laminotomy to T-12 may also reduce the incidence of hip-flexion contractures. The absence of kyphotic deformities in our series, in which the intervention did not extend above the thoracolumbar junction, makes us hesitate