Suprasegmental Effects of Selective Posterior Rhizotomy

Overview

The occurrence of spasticity is most commonly attributed to the lack of presynaptic inhibition. Perinatal damage tothe central nervous system, as it happens in cerebral palsy, leads to pathological reflex response both on segmentaland polysegmental levels. It results not only in clinical signs typical for spasticity but also in alterations of brainstemfunction, such as dysarthria or congenital nystagmus. Selective posterior rhizotomy is a neurosurgical method,routinely used in the treatment of spasticity. The lumbosacral posterior roots are partially cut under perioperativeneurophysiological control. The aim of the treatment is the reduction of afferentation for posterior horns resultingin a decrease of pathological reflex responses. Selective posterior rhizotomy consequently decreases lower limbsspasticity. The improvement of upper extremities fine skills, the improvement of speech and cognitive functions hasbeen also observed after selective posterior rhizotomy. The possible pathophysiological explanations of theseso-called suprasegmental effects are discussed in the article.

Key words:
spasticity, central nervous system, selective posterior rhizotomy, suprasegmental effects.