Selective posterior rhizotomy in the treatment of cerebral palsy, first experience in Czech Republic.

ABSTRACT

BACKGROUND: Selective posterior rhizotomy (SPR) is a surgical treatment of spasticity in patients with cerebral palsy (CP). STARTING POINT We present the first experience with SPR in Czech Republic. MATERIAL AND METHODS: 14 patients with severe spasticity were indicated for SPR during the period of 2 years (2001-2002). The indication criteria were severe spasticity with clonus, more or less symmetric impairment of lower extremities and increased H/M ratio in preoperative electromyography. SPR was performed in 13 cases, in one patient only the revision and intradural neurolysis of caudal roots was done. In all patients we used osteoplastic laminotomy L2-S1. The intraoperative EMG monitoring with selection of rootlets with abnormal response was performed. Preoperative and postoperative number of spasms, passive range of joint movements, Ashworth scale, Peacock grade and level of functional independence were assessed. The comparison of H/M ratio on EMG before and after surgery was performed. RESULTS: An evident improvement in all tested parameters was noted. The per-operative course in all cases was uneventful. Till now, no persistent complications have been observed. CONCLUSION: SPR improves functional ability in a selected group of CP patients. Our findings regarding clinical outcomes are in agreement with those of other authors. In our experience the extrapyramidal symptoms may not be an absolute contraindication of SPR. (Tab. 5, Fig. 3, Ref. 10.).