Functional Posterior Rhizotomy: the Tokyo Experience

Overview

Journal Childs Nerv Syst

Specialty Pediatrics

Date 2007 Jul 27

PMID 17653729

Citations 4

Authors

Nobuhito Morota

Affiliations

Soon will be listed here.

Abstract

Purpose: The author describes the history of functional posterior rhizotomy (FPR), the surgical procedure currently used, and the results together with its future perspective in Japan. The modern form of FPR was introduced to Japan in 1995, and the first surgery was carried out in 1996. Despite initial resistance from orthopedic surgeons, the procedure has eventually gained wide recognition in the country.

Materials And Methods: The author has operated on 98 patients (60 boys and 38 girls, aged from 2 to 19 years old) by the end of 2006. Most patients were mild to severely disabled children with spastic hypertonia because of cerebral palsy and other diseases. The surgical procedure used is based on the Peacock's procedure with some modification for the mildly disabled children whose spasticity was predominantly the muscles of the ankle joint. Intraoperative neurophysiology was an indispensable tool for preserving urogenital function and for judging which root/rootlet to be cut.

Results: Seventeen to 83% of the root/rootlets were found to be abnormal and were cut, clearly correlating with the degree of disability. However, there was a wide difference in the cutting rate, even in children with the same degree of disability. The result of surgery in this group of patients was the same as in previously published data. Twenty out of 51 patients (39%) followed for more than a year at the current institute showed improved locomotion after FPR. Thirty patients (59%) demonstrated suprasegmental effects after FPR.

Conclusion: The role of FPR will grow in importance as a treatment for spasticity in Japan in the future.

Citing Articles

Frequency distribution in intraoperative stimulation-evoked EMG responses during selective dorsal rhizotomy in children with cerebral palsy-part 1: clinical setting and neurophysiological procedure.

Wolter S, Spies C, Martin J, Schulz M, Sarpong-Bengelsdorf A, Unger J Childs Nerv Syst. 2020; 36(9):1945-1954.

PMID: 32577878 PMC: 7434802. DOI: 10.1007/s00381-020-04734-z.

Clinically practical formula for preoperatively estimating the cutting rate of the spinal nerve root in a functional posterior rhizotomy.

Morota N Childs Nerv Syst. 2019; 35(4):665-672.

PMID: 30610480 DOI: 10.1007/s00381-018-04027-6.

Single-level selective dorsal rhizotomy for spastic cerebral palsy.

Graham D, Aquilina K, Cawker S, Paget S, Wimalasundera N J Spine Surg. 2016; 2(3):195-201.

PMID: 27757432 PMC: 5067263. DOI: 10.21037/jss.2016.08.08.

Neurosurgical Management of Childhood Spasticity: Functional Posterior Rhizotomy and Intrathecal Baclofen Infusion Therapy.

Morota N, Ihara S, Ogiwara H Neurol Med Chir (Tokyo). 2015; 55(8):624-39.

PMID: 26227057 PMC: 4628153. DOI: 10.2176/nmc.ra.2014-0445.

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