Use of IONM during Selective Dorsal Root Rhizotomy (SDR) Procedures for the Treatment of Spasticity in Patients with Cerebral Palsy

Selective dorsal root rhizotomy (SDR): SDR has been used effectively in the treatment of spasticity in some children wi…

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Selective dorsal root rhizotomy (SDR): SDR has been used effectively in the treatment of spasticity in some children with cerebral palsy. SDR is a neurosurgical procedure that involves selectively sectioning (cutting) of some of the sensory (dorsal) nerve fibers with abnormal responses that enter the spinal cord and synapse with lower motor neurons. The SDR technique can be used under electrophysiological guidance in a patient with cerebral palsy for the successful treatment of spasticity.
A multimodality Intraoperative Neurophysiological Monitoring (IONM) approach with Somatosensory Evoked Potentials (SSEP), Transcranial electrical Motor Evoked Potentials (TCeMEP), and Electromyography (EMG) is recommended during SDR procedures. Baselines responses are recorded after intubation and before incision under general anesthesia. The spontaneous (s-EMG) and triggered EMG (t-EMG) can be effectively used intraoperatively for the selection of dorsal rootlets. Rootlets with abnormal EMG firing patterns are cut in patients diagnosed with cerebral palsy for the reduction of muscle spasticity.