dc.contributor.author
Wolter, Simone
dc.contributor.author
Spies, Claudia
dc.contributor.author
Martin, John H.
dc.contributor.author
Schulz, Matthias
dc.contributor.author
Sarpong-Bengelsdorf, Akosua
dc.contributor.author
Unger, Joachim
dc.contributor.author
Thomale, Ulrich-W.
dc.contributor.author
Michael, Theodor
dc.contributor.author
Murphy, James F.
dc.contributor.author
Haberl, Hannes
dc.date.accessioned
2022-09-22T11:54:09Z
dc.date.available
2022-09-22T11:54:09Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/36422
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-36138
dc.description.abstract
Introduction: Selective dorsal rhizotomy (SDR) consists of microsurgical partial deafferentation of sensory nerve roots (L1-S2). It is primarily used today in decreasing spasticity in young cerebral palsy (CP) patients. Intraoperative monitoring (IOM) is an essential part of the surgical decision-making process, aimed at improving functional results. The role played by SDR-IOM is examined, while realizing that connections between complex EMG responses to nerve-root stimulation and a patient's individual motor ability remain to be clarified.
Methods: We conducted this retrospective study, analyzing EMG responses in 146 patients evoked by dorsal-root and rootlet stimulation, applying an objective response-classification system, and investigating the prevalence and distribution of the assessed grades. Part1 describes the clinical setting and SDR procedure, reintroduced in Germany by the senior author in 2007.
Results: Stimulation-evoked EMG response patterns revealed significant differences along the segmental levels. More specifically, a comparison of grade 3+4 prevalence showed that higher-graded rootlets were more noticeable at lower nerve root levels (L5, S1), resulting in a typical rostro-caudal anatomical distribution.
Conclusions: In view of its prophylactic potential, SDR should be carried out at an early stage in all CP patients suffering from severe spasticity. It is particularly effective when used as an integral part of a coordinated, comprehensive spasticity program in which a team of experts pool their information. The IOM findings pertaining to the anatomical grouping of grades could be of potential importance in adjusting the SDR-IOM intervention to suit the specific individual constellation, pending further validation.
Trial registration: ClinicalTrials.gov ID: NCT03079362.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
Intraoperative neuromonitoring
en
dc.subject
Lumbosacral level differences
en
dc.subject
Rostro-caudal anatomical distribution
en
dc.subject
Stimulation-evoked EMG response
en
dc.subject
Threshold intensity
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Frequency distribution in intraoperative stimulation-evoked EMG responses during selective dorsal rhizotomy in children with cerebral palsy—part 1: clinical setting and neurophysiological procedure
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.doi
10.1007/s00381-020-04734-z
dcterms.bibliographicCitation.journaltitle
Child's Nervous System
dcterms.bibliographicCitation.number
9
dcterms.bibliographicCitation.originalpublishername
Springer Nature
dcterms.bibliographicCitation.pagestart
1945
dcterms.bibliographicCitation.pageend
1954
dcterms.bibliographicCitation.volume
36
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.funding
Springer Nature DEAL
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
32577878
dcterms.isPartOf.issn
0256-7040
dcterms.isPartOf.eissn
1433-0350