selective posterior rhizotomy

Selective posterior/dorsal rhizotomy (SPR). This technology reduces muscle spasm by eliminating the afferent impulses of muscles. SPR has become an effective method to relieve cerebral palsy and improve motor dysfunction. The advantage is that the sputum is completely relieved, the muscle tension is reduced, and the sensory function is preserved, which can significantly improve the gait and significantly improve the joint deformity caused by muscle spasm. After the muscle tension is lowered, it is convenient for the patient to carry out rehabilitation training and improve daily life. Treatment of diseases: mixed cerebral palsy Indication Surgical indications: SPR surgery is a treatment for sputum, not for all cerebral palsy. It is estimated that almost one-third of patients with cerebral palsy are eligible for this procedure. The indication for surgery is: 1 simple sputum, muscle tension in grade 3 or above. 2 no obvious fixed contracture deformity or only mild deformity. 3 preoperative spine, limbs have a certain ability to exercise. 4 intelligence is normal or close to normal, in order to facilitate postoperative rehabilitation training. 5 severe paralysis and stiffness, affecting daily life, nursing and rehabilitation training. Contraindications Surgical contraindications: 1 mental retardation, can not cooperate with post-operative rehabilitation training. 2 weak muscle strength, low muscle tone. 3 hands and feet, movement, ataxia and twisting. 4 limbs are severely fixed with contracture deformity. 5 severe deformity of the spine and instability of the spine. Surgical procedure (1) Anesthesia and incision: general anesthesia, anesthesia with endotracheal intubation, no muscle relaxant during surgery, to facilitate the observation of muscle movement during nerve threshold electrical stimulation. During the operation, the prone head was lowered, and the abdomen was heightened with an orthopedic frame to reduce the loss of cerebrospinal fluid; 60° hip flexion and 45° knee flexion. The lower limbs are placed under the instrument table for easy observation. The epinephrine-containing physiological saline was injected from both sides of the incision to prevent oozing from the intraoperative incision. According to the preoperative surgical plan, usually in the upper part of the waist 5, waist 2 lower waist 3, the 1 cm wide longitudinal bone groove in the middle of the lamina, the skip laminectomy is performed, and the small joints are retained. After entering the spinal canal, 15 ml of cerebrospinal fluid was taken out for storage before the incision was made. After the surgery, the dura mater was closed and then injected into the hard cavity. (2) posterior root of the spinal nerve: incision of the dura mater, with the intervertebral dural hole as a clue, the nerve root in the intervertebral foramen under the lamina, generally the lumbar 5 nerve root in the lumbar 5 lamina below the intervertebral foramen, And relatively large. Then find 1, can find the waist 4 nerve roots up, if necessary, do the lumbar 4 subplate partial resection. In the waist 2, waist 3 cut open the spine, interspinous ligament, in addition to part of the upper and lower lamina window, cut the dura mater, you can also find the waist 2, waist 3 nerve roots, sometimes by pulling to determine whether it is waist 3 or Waist 4 nerve roots. The posterior root of the spinal nerve is relatively thick in diameter, with few surface vessels, close to the dorsal side, and there is a natural membranous membrane in the posterior root and anterior root, which can be smoothly separated. When the nerve roots are mutated or indistinguishable, a plucking test can be performed on the hooked nerve bundles to observe the condition of the muscle contraction to prevent accidental injury to the nerve anterior root, and the posterior roots are respectively marked with a thin rubber strip. The posterior root of the cervical spinal nerve is clearly arranged, but the traction is small and easy to be damaged. Special care should be taken during the operation. (3) Electrical stimulation method and the amount of posterior root severing of the spinal nerve: After the labeled posterior nerve root is divided into 3 to 5 bundles by a fine surgical separation hook, a nerve threshold electrical stimulator is used, and each small bundle is stimulated by an electrical stimulation hook, and observed. Control the activity of the muscles. The dominant muscle has a wide range of expansion, and the nerve beam has a low stimulation threshold and high excitability. The nerve beam is excised about 0.5 to 1.0 cm. The ratio of each posterior root resection: general muscle tension level III or more cut 50%, pathological reflex cut 50%, muscle tension level II cut 30%, waist 3, waist 4 cut 30%, to ensure four heads Muscle strength. After the posterior root of the spinal nerve is cut, carefully arrange the nerve bundles in the spinal canal to remove the blood clot. The dura mater was closed with a 5-0 non-invasive suture with continuous suture stitching, and the cerebrospinal fluid was stored in the epidural. The epidural injection is covered with sodium hyaluronate (sodium hyaluronate) or fat with blood around it to prevent adhesion. The other side was used as a drainage tube incision, and the negative pressure drainage tube was drained for 1 day. complication 1. Low muscle tone, unsatisfactory sputum release, cerebrospinal fluid leakage and sensory loss. 2, some older patients may also have problems such as lumbar spondylolisthesis and scoliosis. 3, in the long-term may also occur in the surgical area nerve root adhesion and other issues.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.