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Journal of the Korean Academy of Rehabilitation Medicine 1993;17(4):540-548.
The effect of selective posterior rhizotomy for the treatment of spastic upper extremity dysfunction.
Kim, Yun Hee , Kim, Hyoung Ihl
Department of Rehabilitation Medicine and Neurosurgery*, Medical School, Chonbuk National University
경직성 상지기능장애에 대한 선택적 척수신경 후근절제술의 치료효과
김연희, 김형일*
전북대학교 의과대학 재활의학교실 및 신경외과학교실*

Posterior rhizotomy was proposed in 1908 by Otfrid Foerster for the treatment of spasticity and modified by Gros and Fasano to sacrifice the rootlet believed to be most responsible for spasticity on the bases of electrophysiologic techniques. Selective posterior rhizotomy(SPR) was frequently performed at the lumosacral roots to reduce the spasticity and improve the function of lower extremities in diplegic or quadriplegic patients. SPR can be applied at cervical roots to manage the spastic upper extremity dysfunction as suggested by Gros et al in 1979.

We performed SPR in 8 patients who had the spastic upper extremity dysfunction with the 8-channel electromyographic monitoring. The spasticity and han function were evaluated before and after surgery. The results are as follows:

1) The subjects were 7 patients with cerebral palsy and one with spinal cord injury. Six patients were hemiplegic and 2 patients were quadriplegic. All had spasticity in affected side and 3 had combined dystonia.

2) In all the patients spasticity was decreased and deformity of hand was improved after receiving SPR.

3) Five patients out of 8 showed improvement in hand function evaluated by the grip and pinch strength, 9-hole peg test, and Jebsen hand function test.

4) The performance in activities of daily living was improved after surgery in 4 patients including all quadriplegic patients.

5) Six patients expressed satisfaction to the results of surgery in terms of improvement in cosmetic view, function and ease for hygienic care.

SPR of cervical nerve roots was considered as an effective method of treatment for the spastic dysfunction of upper extremity without noticeable complication.

Key Words: Selective posterior rhizotomy, Cervical nerve root, Spasticity, Upper extremity


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