Ultra-selective Conus Dorsal Rhizotomy for Spasticity; Technical Note and Step-by-Step Operative Technique

Background Selective dorsal rhizotomy (SDR) has long been recognized as a gold standard intervention for managing spasticity in children with cerebral palsy; however, its implementation often lacks specificity in technique, leading to varying outcomes. Our research introduces "ultra selective dorsal rhizotomy" (USDR), aiming to refine the traditional SDR approach through precise evaluation and targeting of rootlets. This study aims to evaluate the efficacy of USDR in reducing spasticity and improving functional outcomes in paediatric patients with spastic cerebral palsy, utilizing a systematic, neurophysiological monitoring approach. Methods We conducted a prospective, longitudinal study involving children diagnosed with spastic cerebral palsy and adults, selected based on strict clinical and radiological criteria. The USDR technique was performed using a two-step grading process: primary grading of roots followed by secondary grading of root divisions (rootlets), with intraoperative neurophysiological monitoring guiding the selection and sectioning of targeted nerve rootlets. Results Postoperative assessments demonstrated a significant reduction in spasticity, as evidenced by improved scores on the Ashworth Scale, and Gross Motor Function Measure with no newly developed deficits or serious complications reported. The results indicate a positive trend toward enhanced functional mobility in the patients studied. Conclusion The introduction and specification on terminology using USDR represents a more detailed specific systemic approach for the treatment of spasticity, offering a refined approach that combines selectivity with neurophysiological two-step of verification and precision. These preliminary findings suggest that USDR may improve surgical outcomes, and further studies are warranted to validate its long-term efficacy and safety.