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Lauri V. Laitinen, Stefan Nilsson and Axel R. Fugl-Meyer

P osterior rhizotomy was proposed in 1908 by Otfrid Foerster 4 for the treatment of spasticity. The L-2, L-3, L-5, and S-2 posterior roots were divided in four patients. One of the patients died, but three were reported to have obtained good clinical improvement. In 1913, Foerster 3 reported similar operations on a series of 159 patients. For some reason his method remained unpopular until 1967 when Gros, et al. , 5 published their results of partial posterior rhizotomy. In the meantime, Munro 9 had developed the technique of anterior rhizotomy, MacCarty

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Renee M. Reynolds, Ryan P. Morton, Marion L. Walker, Teresa L. Massagli and Samuel R. Browd

S pasticity , defined as a velocity-dependent increase in the tonic stretch reflex, can arise due to a variety of neurological insults that cause upper motor neuron dysfunction. These include cerebral palsy, neurodegenerative disorders, and traumatic brain and spinal cord injuries. 6 , 14 Spasticity associated with spinal cord injury (SCI) can be severe and may cause a variety of debilitating symptoms. These may include painful muscle spasms that negatively impact transfers, hinder the independent performance of activities of daily living (ADL) and

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Bernardo Fraioli and Beniamino Guidetti

F örster's method of treating spasticity 1 has been criticized because of subsequent disorders of sensation, trophic changes, and its effects on functional reeducation. A technical modification of this method, which reduces sensation disorders and excludes the trophic changes, has been introduced by Gros, et al. 7 It consists of a complete section of all but one or two of the rootlets that constitute the posterior roots. Another technique, which consists of a selective intramedullary section at the level of the posterior spinal cord-rootlet junction, has

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A. Leland Albright and Elizabeth C. Tyler-Kabara

S econdary dystonia is associated most often with CP, but can occur after traumatic brain injuries, strokes, or other disorders that affect the basal ganglia, usually the putamen. Secondary dystonia can be focal, segmental, hemidystonia, or generalized. Dystonic CP is generalized in most cases and affects the face, neck, trunk, and all extremities. Dystonia can be mild or severe, and if severe, it causes discomfort, impedes caregiving, and may interfere with function. In children with CP, dystonia often coexists with spasticity in the extremities

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Peter C. Gerszten, A. Leland Albright and Graham F. Johnstone

C erebral palsy (CP) affects approximately 750,000 individuals in the United States, with an incidence of 1.5 to 2.5 per 1000 live births. 1, 19 Given the increased survival rates among the lower-birth-weight groups, the rate of CP is actually increasing worldwide. The National Institutes of Health has estimated societal costs at $5 billion for care of individuals with CP who are younger than 18 years of age. 1 Cerebral palsy is characterized by abnormalities of movement, including spasticity, athetosis, chorea, dystonia, and ataxia. Two-thirds of the

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Richard D. Penn and Jeffrey S. Kroin

S evere spasticity and associated flexor and extensor spasms frequently cause pain and suffering in neurologically impaired patients. Oral medications have only slight modulating effects and are often poorly tolerated at the high doses necessary to bring the symptoms under partial control. 5, 6 Neurosurgeons, challenged by this clinical problem, have devised a number of operative procedures. At the turn of the century dorsal rhizotomies were employed, and then a range of alternative procedures such as myelotomies, anterior rhizotomies, and even cordectomies

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Robert F. Heimburger, Anita Slominski and Patricia Griswold

S pasticity , one of the most common and disabling neurological disorders, is alleviated very little by available treatment. Drugs, occupational and physical therapy, and muscle lengthening or transfer have only a limited benefit. Operations on the nervous system have not been widely used because it is difficult to relax muscles without paralyzing them. A variety of stereotaxic surgical techniques for alleviating spasticity have been tried. In 1970, Kottke 3 reported decreased spasticity in six patients with cerebral palsy following bilateral cervical

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Yves Lazorthes, Brigitte Sallerin-Caute, Jean-Claude Verdie, Raymond Bastide and Jean-Pierre Carillo

T reatment of spasticity by direct spinal intrathecal administration of a specific gamma-aminobutyric acid (GABA)-B agonist, baclofen, is a new pharmacological concept in functional neurosurgery. This method, proposed in 1984 by Penn and Kroin 25 who conducted further experimental work on this approach, 14, 24 has been used and perfected by various groups working in cooperation using a multidisciplinary protocol. 10, 16–20, 23, 26, 31, 32 The number of patients treated and the follow-up period were sufficient to demonstrate the efficiency and safety of the

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

S elective dorsal rhizotomy (SDR) is a standard treatment option for spastic paraparesis associated with cerebral palsy (CP) in selected patients. However, the diagnosis of CP encompasses a broad variety of underlying pathologies that appear early in life secondary to a brain lesion or dysfunction that is not the result of progressive or degenerative brain disease. 2 Cerebral palsy arises from a diversity of causes and can affect widely variable anatomy. Despite this heterogeneity, outcomes and complications of SDR within this patient population have been

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Lauri Laitinen and Evangelos Singounas

T reatment of severe spasticity of the legs is a difficult neurosurgical and orthopedic problem. The aim must be to preserve, if not to improve, the residual mobility, sensation, and bladder function. All the conventional methods aimed at the interruption of the peripheral reflex arc have disadvantages. Section of the posterior roots, as advocated by Foerster 3 in 1913, has sometimes caused a widespread sensory loss and increased the risk of bedsores. The anterior root section of Munro 6 produces irrevocable paralysis. Cordectomy, described by MacCarty and