Selective dorsal rhizotomy

Rhizotomy
Pronunciation/raɪˈzɒtəmi/[1][2] ry-ZOT-ə-mee
ICD-9-CM03.1
MeSHD019051

A selective dorsal rhizotomy (SDR), also known as a rhizotomy, dorsal rhizotomy, or a selective posterior rhizotomy, is a neurosurgical procedure that selectively cuts problematic nerve roots in the spinal cord.[3][note 1] This procedure has been well-established in the literature as a surgical intervention and is used to relieve negative symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy.[4] The specific sensory nerves inducing spasticity are identified using electromyographic (EMG) stimulation and graded on a scale of 1 (mild) to 4 (severe spasticity). Abnormal nerve responses (usually graded a 3 or 4) are isolated and cut, thereby reducing symptoms of spasticity.[3]

Spasticity is defined as a velocity-dependent increase in muscle tone in response to a stretch.[5] This upper motor neuron condition results from a lack of descending input from the brain that would normally release the inhibitory neurotransmitter gamma amino butyric acid (GABA), which serves to dampen neuronal excitability in the nervous system.[6] Spasticity is thought to be caused by an excessive increase of excitatory signals from sensory nerves without proper inhibition by GABA.[7] Two common conditions associated with this lack of descending input are cerebral palsy and acquired brain injury.[6]

  1. ^ "Rhizotomy". Lexico UK English Dictionary. Oxford University Press. Archived from the original on 2020-01-11.
  2. ^ "Rhizotomy". Merriam-Webster.com Dictionary. Merriam-Webster. Retrieved 2016-01-21.
  3. ^ a b "Selective Dorsal Rhizotomy (SDR) Surgery for Cerebral Palsy | St. Louis Children's Hospital". www.stlouischildrens.org. Retrieved 2017-11-12.
  4. ^ Park, Tae Sung; Johnston, James M. (2006). "Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy". Neurosurgical Focus. 21 (2): 1–6. doi:10.3171/foc.2006.21.2.8. S2CID 25748850.
  5. ^ Mukherjee, Angshuman; Chakravarty, Ambar (2010-12-17). "Spasticity Mechanisms – for the Clinician". Frontiers in Neurology. 1: 149. doi:10.3389/fneur.2010.00149. ISSN 1664-2295. PMC 3009478. PMID 21206767.
  6. ^ a b Lundy, C; Lumsden, D; Fairhurst, C (September 2009). "Treating complex movement disorders in children with cerebral palsy". The Ulster Medical Journal. 78 (3): 157–163. ISSN 0041-6193. PMC 2773587. PMID 19907680.
  7. ^ Rumberg, Franziska; Bakir, Mustafa Sinan; Taylor, William R.; Haberl, Hannes; Sarpong, Akosua; Sharankou, Ilya; Lebek, Susanne; Funk, Julia F. (2016-04-04). "The Effects of Selective Dorsal Rhizotomy on Balance and Symmetry of Gait in Children with Cerebral Palsy". PLOS ONE. 11 (4): e0152930. Bibcode:2016PLoSO..1152930R. doi:10.1371/journal.pone.0152930. ISSN 1932-6203. PMC 4820221. PMID 27043310.


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