How I do it: single-level selective dorsal rhizotomy with intraoperative neurophysiological monitoring from T12/L1 to S2 for pediatric spasticity

Single-level selective dorsal rhizotomy (SDR) is an established treatment for non-progressive spasticity (e.g. cerebral palsy) in children but with notable variability across centers. We describe a single-level laminoplasty technique with dural opening at the level of the conus medullaris , allowing for electrophysiological examination of sensitive roots from T12 to S2. This involves the systematic sectioning of two-thirds of the dorsal roots, selected based on pathological responses of muscles to stimulation and a tailored approach regarding S2 section or conservation. This approach combines reliable anatomical landmarks with comprehensive lumbosacral mapping, achieving permanent spasticity reduction with no neurological morbidity.