[Posterior selective rhizotomy in the treatment of severe spastic syndrome in cerebral palsy].

Background: Aim of this study was to optimize surgical technique of posterior selective rhizotomy for prevention of possible complications.

Materials And Methods: 11 patients (age 3-30 years) with severe spastic tetraparesis due to cerebral palsy were operated. Muscle tone in lower limbs reached 4-5 points (Ashworth scale). In all cases posterior selective rhizotomy of L1-S1 spinal roots was performed using laminoplasty and intraoperative electromyographic monitoring. Results were assessed in early postoperative period and during follow-up.

Results: In all cases in the early postoperative period we observed decrease of muscle tone to 1-2 points and increase of volume of passive movements. In the follow-up period 4 patients developed improvement of locomotor status, in 6 no changes were observed. In 1 case spastic syndrome recurred. We had no complications due to orthopaedic deformities of spinal column, sensory and pelvic disorders, muscular hypotonia.

Conclusion: Posterior selective rhizotomy may be the method of choice in treatment of patients with severe spastic forms of cerebral palsy. Application of optimized surgical technique (laminoplasty, intraoperative stimulation electromyography) allows to decrease the risk of possible complications.