Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1133-1141
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1133
Selective dorsal rhizotomy in cerebral palsy spasticity - a newly established operative technique in Slovenia: A case report and review of literature
Tomaz Velnar, Peter Spazzapan, Zoran Rodi, Natasa Kos, Roman Bosnjak
Tomaz Velnar, Peter Spazzapan, Roman Bosnjak, Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Tomaz Velnar, AMEU-ECM Maribor, Ljubljana 1000, Slovenia
Zoran Rodi, Department of Neurophysiology, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Natasa Kos, Medical Rehabilitation Unit, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
Author contributions: Velnar T, Spazzapan P, Rodi Z, Kos N and Bosnjak R contributed equally to this work; Velnar T, Spazzapan P, Rodi Z, Kos N and Bosnjak R designed research; Velnar T and Spazzapan P performed research; Rodi Z, Kos N and Bosnjak R analyzed data; and Velnar T, Spazzapan P, Rodi Z, Kos N and Bosnjak R wrote the paper.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tomaz Velnar, MD, PhD, Assistant Professor, Doctor, Department of Neurosurgery, University Medical Centre Ljubljana, Zaloska 7, Ljubljana 1000, Slovenia. tvelnar@hotmail.com
Telephone: +00-386-15223250
Received: November 15, 2018
Peer-review started: November 16, 2018
First decision: January 12, 2019
Revised: April 23, 2019
Accepted: May 1, 2019
Article in press: May 2, 2019
Published online: May 26, 2019
Abstract
BACKGROUND

Spasticity affects a large number of children, mainly in the setting of cerebral palsy, however, only a few paediatric neurosurgeons deal with this problem. This is mainly due to the fact that until 1979, when Fasano has published the first series of selective dorsal rhizotomy (SDR), neurosurgeons were able to provide such children only a modest help. The therapy of spasticity has made a great progress since then. Today, peroral drugs, intramuscular and intrathecal medicines are available, that may limit the effects of the disease. In addition, surgical treatment is gaining importance, appearing in the form of deep brain stimulation, peripheral nerve procedures and SDR. All these options offer the affected children good opportunities of improving the quality of life.

CASE SUMMARY

A 15-year old boy is presented that was surgically treated for spasticity as a result of cerebral palsy. Laminotomy at L1 level was performed and L1 to S1 nerve roots were isolated and divided in smaller fascicles. Then, the SDR was made.

CONCLUSION

We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time.

Keywords: Cerebral palsy, Spasticity, Selective dorsal rhizotomy, Operation, Case report

Core tip: Spasticity affects a large number of children, mainly in the setting of cerebral palsy. The therapy of spasticity has made a great progress. Today, peroral drugs, intramuscular and intrathecal medicines are available. In addition, surgical treatment is gaining importance. We describe a patient report and surgical technique of SDR that was performed in Slovenia for the first time and successfully introduced in the clinical practice.