Privat J M, Benezech J, Frerebeau P, Gros C
Acta Neurochir (Wien). 1976;35(1-3):181-95. doi: 10.1007/BF01405946.
After their experience of Foerster's operation and its technical modifications in 80 cases the authors report a new concept of analysis and treatment of spasticity in lower limbs. Spasticity of the different muscle groups is classified either as "useful spasticity" or "handicapping spasticity". The first has to be preserved, the second must be reduced. In order to achieve this purpose a new technique is presented, based on operative sectorial identification of the posterior rootlets subserving the "handicapping spasticity" by electrophysiological stimulation, muscle testing, and E.M.G. studies. The conus medullaris and cauda equina are exposed by T 11-L 1 laminectomy, performed in the lateral position. The clinical and E.M.G. evaluation of responses to stimulation enables the surgeon to establish a map of rootlet groups which are marked with coloured threads. Selective resection of "handicapping posterior rootlets" is then performed after several tests of the mapping. The rootlets subserving useful spasticity are carefully preserved. Ten cases are reported, comprising five cases of cerebral palsy operated upon since 1974 and five cases of posttraumatic spastic paraplegia from the same period. Pre and postoperative findings are summarized. The technical features of this procedure are discussed and compared with other surgical procedures. The problem of the rootlet reflex arch is considered in the light of the effects of stimulation of anterior and posterior rootlets at the same level.
在对80例患者进行了福斯特手术及其技术改良后，作者报告了一种关于下肢痉挛分析与治疗的新概念。不同肌肉群的痉挛分为“有用性痉挛”或“致残性痉挛”。前者需予以保留，后者则必须减轻。为实现这一目的，提出了一种新技术，该技术基于通过电生理刺激、肌肉测试和肌电图研究对支配“致残性痉挛”的后根小束进行手术局部识别。通过在侧卧位进行T 11 - L 1椎板切除术暴露脊髓圆锥和马尾。对刺激反应的临床和肌电图评估使外科医生能够绘制出用彩色线标记的后根小束图谱。在对图谱进行几次测试后，然后进行“致残性后根小束”的选择性切除。仔细保留支配有用性痉挛的后根小束。报告了10例病例，包括1974年以来接受手术的5例脑瘫患者和同期的5例创伤后痉挛性截瘫患者。总结了术前和术后的结果。讨论了该手术的技术特点，并与其他手术方法进行了比较。根据对同一水平前根和后根刺激的效果，考虑了后根小束反射弧的问题。
