In:
Developmental Medicine & Child Neurology, Wiley, Vol. 65, No. 1 ( 2023-01), p. 78-85
Abstract:
To explore – through intraoperative neurophysiology mapping and recordings – the comparative distribution of the reflexive excitability of the L2 to S2 radiculo‐metameric segments of the spinal cord in a series of children with bilateral spastic cerebral palsy (CP) who underwent selective dorsal rhizotomy (SDR). Method Our series included 46 consecutive children (36 males, 10 females; aged 5–16 years, mean 8 years) who underwent SDR, using keyhole interlaminar dorsal rhizotomy. The procedure allowed access to all L2 to S2 roots independently, while preserving the posterior architecture of the lumbar spine. Dorsal roots were stimulated selectively to test reflexive excitability of the corresponding radiculo‐metameric levels. Stimulation parameters were identical for all roots for optimal comparison between root levels, with an intensity just above threshold to avoid excessive diffusion. The responses in the main muscular groups in each lower limb were clinically observed and electromyograms recorded. Degrees of excitability were quantified according to Fasano's scale. Results The difference between root levels was highly significant. Median values of excitability were 1, 2, 3, 3, 3, and 3 for the L2, L3, L4, L5, S1, and S2 levels respectively. Lower root levels exhibited significantly more excitability. Interpretation In addition to insight into the spasticity of children with CP, the profile of segmental excitability can be useful in establishing surgical planning when programming SDR. What this paper adds Keyhole interlaminar dorsal rhizotomy modality allowed selective stimulation of all L2–S2 dorsal roots for testing excitability. There were significant differences in reflexive excitability of L2–S2 radiculo‐medullary segments. Lower segments of L2–S2 medullary levels have higher excitability. Interindividual variability in excitability of lumbosacral segments justifies intraoperative neurophysiology. This original article is commented on by Young on pages 9–10 of this issue.
Type of Medium:
Online Resource
ISSN:
0012-1622
,
1469-8749
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
80369-8
detail.hit.zdb_id:
2001992-0
