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Ann Clin Neurophysiol > Volume 1(1); 1999 > Article
Ann Clin Neurophysiol. 1999; 1(1): 19-25.
Selective Dorsal Rhizotomy for Spastic Paraplegia in Cerebral Palsy Using Intraoperative Electromyography Monitoring
Jong-Min Kim, Kyu-Chang Wang, Moon-Suk Bang, Chin Youb Chung, and Kwang-Woo Lee
Copyright © 1999 The Korean Society of Clinical Neurophysiology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background & Objectives :In cerebral palsy, spastic paraplegia is one of the most crippling motor manifestations. Reducing the spasticity may improve gait and decrease the incidence of lower-extremity deformities. The spasticity may result from abnormally increased afferent signals via dorsal roots onto interneurons and anterior horn and spreading of reflex activation to other muscle groups. To assess the influence of dorsal rhizotomy to spasticity, the authors analyzed five cerebral palsy patients with spastic paraplegia. Methods : The operation entailed and L1-2 laminectomy, ultrasonographic localization of conus medullaris and identification of lumbosacral dorsal roots. The innervation patterns of each dorsal root were examined by electromyography (EMG) responses to electrical stimulation. Tetanic stimulation was applied to individual rootlets of each root after reflex threshold was determined. the reflex responses were graded and rootlets producing high grade response were selected and cut. Short-term postoperative evaluations were performed. Results : Intraoperative EMG monitoring was satisfactorily performed in all five cases. One month after the operations, all patients showed greatly reduced spasticity which was measured by the instrumental gait analysis. Bilateral knn and ankle jerks were normalized and tip-toe gait with scissoring disappeared in all patients. Conclusion : Intraoperative EMG monitoring seems useful for the selective dorsal rhizotomy to reduce spasticity.
Key words: Cerebral palsy, Selective dorsal rhizotomy, EMG monitoring
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