Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital University of Medical Science, No. 45 Changchun Street, Xicheng District, Beijing 100053, China.
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital University of Medical Science, No. 45 Changchun Street, Xicheng District, Beijing 100053, China.
J Clin Neurosci. 2014 Jan;21(1):116-20. doi: 10.1016/j.jocn.2013.04.020. Epub 2013 Oct 20.
Pure hereditary spastic paraparesis usually presents with progressive weakness and spasticity of the legs, which is similar to spastic cerebral palsy. In this study selective dorsal rhizotomy (SDR) was performed to improve the spasticity of pure hereditary spastic paraparesis and the long-term results were followed. A series of four patients with pure hereditary spastic paraparesis diagnosed by a multidisciplinary team received SDR. The dorsal rootlets from the L2 to S1 levels were selectively resected under electrophysiological monitoring. The patients were followed up for more than 2 years to evaluate the outcome of surgery. There was a significant reduction in muscular spasm after SDR. Standing and walking stability were improved in all patients which led to improvement in walking posture and longer walking distance without assistance. No urinary retention, cerebrospinal fluid leak, surgical infection or kyphosis occurred. For severe pure hereditary spastic paraparesis, SDR can reduce muscle spasm and improve standing and walking stability. These results were stable throughout follow-up. SDR performed at the level of the conus medullaris through a laminectomy from T12 to L1 or L1 to L2 requires a shorter incision, laminectomy of fewer segments, and has a shorter operation time than the usual method (laminectomy from L2 to S1). Intraoperative electrophysiological monitoring is helpful to discriminate abnormal rootlets and protect sphincter function.
纯遗传性痉挛性截瘫通常表现为腿部进行性无力和痉挛，类似于痉挛性脑瘫。本研究对纯遗传性痉挛性截瘫患者施行选择性脊神经根切断术（SDR）以改善其痉挛状态，并对长期疗效进行随访。一组由多学科团队诊断为纯遗传性痉挛性截瘫的 4 例患者接受了 SDR 治疗。在电生理监测下，选择性切除 L2 至 S1 水平的脊神经根。对患者进行了 2 年以上的随访，以评估手术效果。SDR 后肌肉痉挛明显减轻。所有患者的站立和行走稳定性均得到改善，从而改善了行走姿势和更长的无辅助行走距离。无尿潴留、脑脊液漏、手术感染或后凸畸形发生。对于严重的纯遗传性痉挛性截瘫，SDR 可以减轻肌肉痉挛，改善站立和行走稳定性。这些结果在随访期间保持稳定。与通常的从 L2 至 S1 行椎板切除术的方法相比，经 T12 至 L1 或 L1 至 L2 的椎板切除术行 SDR 于马尾水平施行，需要的切口更短、椎板切除节段更少、手术时间更短。术中电生理监测有助于区分异常神经根并保护括约肌功能。
