Lack of specificity in electrophysiological identification of lower sacral roots during selective dorsal rhizotomy

Journal of Neurosurgery
J G OjemannB A Kaufman

Abstract

The authors investigated the efficacy of anal sphincter electromyography (EMG) in identifying the lower sacral roots during selective dorsal rhizotomy. In nine children undergoing selective dorsal rhizotomy for cerebral palsy (CP) spasticity, direct electrical stimulation of the L1-S5 dorsal and ventral roots was performed while monitoring EMG responses from the anal sphincter and lower-extremity muscles. Anal sphincter activation was seen with stimulation of lumbosacral roots at many levels. Stimulation of dorsal and ventral roots gave anal sphincter EMG responses in 100% of the dorsal and ventral roots from L-4 and caudally. Only at the L-1 level did a minority of nerve roots have anal sphincter response to stimulation. Patterns of extremity muscle and sphincter activation specific to the S3-5 roots, namely anal sphincter activation without activation of other muscle groups, were found in only five (22%) of 23 roots stimulated. The pattern of stimulation responses in the majority of S3-5 roots indicated that the pathophysiology of lower-extremity spasticity in CP may involve the anal sphincter and does not spare the lower sacral roots. Thus, this study indicates that electrophysiological mapping alone, without anatomical iden...Continue Reading

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Citations

Mar 1, 1999·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland· Hajivassiliou, Finlay
Mar 10, 2001·Mental Retardation and Developmental Disabilities Research Reviews·M C Petersen, F B Palmer
May 21, 1998·Developmental Medicine and Child Neurology·J F McLaughlinN Temkin

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