Spinal cord tethering after selective dorsal rhizotomy below the conus medullaris
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Conus medullaris
Rhizotomy
Syrinx (medicine)
Objective Selective posterior rhizotomy (SPR) of L2-S1 at conus medullaris level was performed and the procedure's results were followed up. Method SPR of L2-S1 at conus medullaris level through T12 to L2 laminectomy was performed on 22 patients suffering from spastic cerebral palsy, the change of spasticity and motor abilities were investigated through 6 months followed up. Result Reduction of spasticity was observed in all the muscular groups, and all the patients presented functional improvement of motor abilities. No patients developed serious complications. Conclusion SPR at medullaris level has showed a satisfactory result with a limited injury.
Rhizotomy
Conus medullaris
Spastic cerebral palsy
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Objective To explore the ways to improve surgical techniques in SPR,chiefly to Lessen the injuries to the spine and the incidental rate of long term postoperative complications Methods Laminectomy was performed only in one and a half vertebra on the level of the spinal cone, which was located by MRI before the operation After the dura mater was opened,the posterior roots of the spinal nerve from L 2 to S 1 were discriminated and separated at the level of conus medullaris where the caudal equine originates,Some lower threshold rootlets were incised after the selection of electrical stimulation The key point of the operation depended on the separation of different levels of the posterior roots of the spinal nerve Results Ten cases with spastic paralysis of the limbs,which resulted from cerebral palsy,were treated All were followed up for 4 to 6 months Nine patients with pure spastic palsy had good success Their muscle tone came to normal levels The appearence of scissors gait vanished The ranges of limb movement increased The control of muscular movement improved One patient with mixed form of spasticity and athetosis had muscular tone improvement in the repose situation but still had some difficulty when active Seven patients who had spasticity in the upper limbs before operation had improvement to different extensts after operating Conclusion The posterior roots of the spinal nerves of the lower limbs were concentrated at the plane of cone where they originated When performing SPR at this level,it revealed the posterior roots,which just requried only a one and a half vertebra laminectomy The injuries to the spine and the operating complication were evidently reduced as a resutl
Rhizotomy
Conus medullaris
Muscle tone
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Cape
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Conus medullaris
Rhizotomy
Cauda equina
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We describe a variation of selective dorsal rhizotomy for spastic cerebral palsy that involves sectioning of the dorsal spinal roots immediately caudal to the conus medullaris. The operation entails an L1-L2 laminectomy, ultrasonographic localization of the conus medullaris, and partial deafferentation of the L1-S2 roots with electromyographic testing under an operating microscope. In 66 children with cerebral palsy, the operation reduced spasticity in the lower extremity without complications, e.g., motor weakness, neurogenic bladder, and sensory loss. It offers several important advantages over alternative techniques.
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Conus medullaris
Clonus
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Selective dorsal rhizotomy (SDR) is a procedure primarily performed to improve function in a subset of children with limitations related to spasticity. There is substantial variability in operative techniques among centers and surgeons. Here, the authors provide a technical review of operative approaches for SDR.
Rhizotomy
Conus medullaris
Laminoplasty
Spinal Deformity
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Conus medullaris
Rhizotomy
Syrinx (medicine)
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Fifty-nine patients were identified with 70 gastrointestinal tract complications from a review of 950 spinal cord injury patients admitted during a 10-year period (prevalence 6.2%). When compared to a random spinal-cord-injured noncomplication control group (N = 31 patients), there was no difference in the percentage of low-dose steroids (dexamethasone 40 mg/day) given or in the percentage of patients receiving ulcer prophylaxis. All but two patients in the complication group received ulcer prophylaxis. Although an increase in the percentage of cervical and complete lesions was seen in the bleeding complications group, this increase was not statistically significant. The low complication rate (6.2%) seen in this study probably reflects the global use of ulcer prophylaxis and heightened awareness at a regional spinal cord injury center.
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Rhizotomy
Conus medullaris
Cauda equina
Clonus
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