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CHAPTER 31
(b) Posterior rhizotomy
Foerster, in 1911, reported on the beneficial effect of posterior root sections in 81 cases
of spastic paralysis of various aetiologies—among them four cases of traumatic paraplegia,
but in only two of which proved
this operation
to be
effective.
Freeman
& Heimburger (1948) tried this method in two cases without success, which is in accord
ance with the experience of previous authors (Kreuz, 1932; Lehmann, 1936; Tarlov,
1966). My personal experience of posterior rhizotomy, gained at Foerster's clinic and
later in my own department at the Jewish Hospital, Breslau, is in accordance with these
authors. In spite of excellent initial success in spastic cases, recurrence of spasticity
occurred, despite extensive posterior rhizotomy from Li-S3 (Guttmann, 1931). This is
understandable, if one remembers that in selective posterior rhizotomy the input from
the remaining posterior roots will sooner or later compensate the lost afferent impulses
of the divided roots.
(c) Anterior rhizotomy
Munro advocated anterior rhizotomy for relieving intractable spasticity (1945, 1948).
He suggested division of the anterior roots from Ti2 to 82 and reported satisfactory
results in numerous cases in transforming the spastic lesion into a flaccid lower motor
lesion. He recommended electrical stimulation of the sacral roots prior to their resection
while cystomy was carried out in order to preserve satisfactory bladder function. Martin
& Davis (1948) resected as high as Tio and they and Elkins & Wegner (1946), Maltby
(1945), Freeman & Heimburger (1947) and others confirmed Munro's views. Dick (1949)
mentions seven cases of the Spinal Unit, Winnick, where anterior rhizotomy was per
formed by Sutcliffe Kerr from Tio to Si with the result that spasticity was abolished in
several cases and the bladder capacity increased. However, in 5 of the 7 cases, the sexual
erection reflex was abolished. Mayfield (1945) and Kennedy (1946) stressed the point
that anterior rhizotomy is indicated in selected cases only—a view with which I agreed
(Guttmann, 1946, 1953). Recently, Sutcliffe Kerr (1966) reviewed 30 cases (23 males, 7
females) in which he performed this operation, 19 of them being traumatic cord lesions
above Tio. In all cases, the spasticity was more or less relieved in the legs. Sutcliffe Kerr
does not claim that this procedure is necessarily superior to other methods of prevention
and treatment of spasticity but points out that it can be a useful procedure in certain
circumstances. The operation may be indicated in a patient who is desperately ill from
extensive pressure sores or urinary infection or is suffering intolerably from frequent
spasms and yet may be in good general condition. Other authors mentioned certain
disadvantages with this procedure which deserves serious consideration:
1
Identification of the spinal roots is not always a simple matter, as pointed out by
Botterell, Macdonald & Mackenzie (1946). The difficulty of root identification is obviously
increased in more distal cord lesions, when injury to the spine has more or less resulted
in spinal deformities and alterations in the topographical relations.
2
If not only the leg muscles but also the abdominal muscles, such as in mid and upper
thoracic as well as cervical lesions, are involved in violent spasms, a very extensive
