Intraoperative Electrophysiological Monitoring During Selective Dorsal Rhizotomy in Children with Spastic Cerebral Palsy

Background: Selective dorsal rhizotomy (SDR) is an established strategy for treating spastic cerebral palsy. The applied techniques and criteria of intraoperative electrophysiological monitoring (EPM) for selected transected rootlets vary between different centers; therefore its validity has been questioned. Objective: The aim of this study is to evaluate the applied techniques of EPM used during SDR for treating spasticity in Egyptian children with cerebral palsy. Methods: Twenty-two children (14 boys and 8 girls) underwent EPM guided SDR. Percentage of abnormal (grades 3+ and 4+) and transected rootlets and presence of anal sphincter related fibers in S1 were estimated. Postoperative clinical outcome after 6 months was assessed for 8 cases including assessment of power of quadriceps; range of movement (ROM) of hip abduction; and tone grading of adductor muscles. Results: Using EPM, 52.8% of stimulated rootlets in each dorsal root was graded as 3+ or 4+ was transected. In 6 children (27%), the first sacral (S1) dorsal root produced anal sphincter contraction. At 6 months postoperative, significant increase of ROM of hip abduction; insignificant decrease of spasticity of adductor muscles; and insignificant improvement of motor power of quadriceps are detected. No postoperative complications were detected. Conclusion: The present study demonstrates that the applied EPM procedures during SDR provide an objective way for selecting transected rootlets and avoiding postoperative complications. [Egypt J Neurol Psychiat Neurosurg. 2010; 47(3): 505-510]