Dorsal Rhizotomy: Neurosurgery for Childhood Spasticity

Dr. Morota graduated from Shinshu University School of Medicine in Matsumoto in 1981. Following his postgraduate training in Yamanashi, he joined the Department of Neurosurgery at Shinshu University. His career as a pediatric neurosurgeon began in 1986, during a year-long clinical fellowship at Kobe Children’s Hospital. He became a board-certified neurosurgeon in Japan in 1989.In 1991, Dr. Morota joined the Division of Pediatric Neurosurgery at New York University Medical Center, where he served as a clinical fellow specializing in intraoperative neurophysiology and pediatric neurosurgery. Upon returning to Japan in 1995, he advanced his expertise in spinal and epilepsy surgery at Aichi Medical University and the National Niigata Chuo Hospital.In 2002, Dr. Morota was appointed Director of the Division of Neurosurgery at the newly established National Center for Child Health and Development in Tokyo. Under his leadership, the division became the largest pediatric neurosurgical service in Japan. In 2014, he moved to Tokyo Metropolitan Children’s Medical Center and later served as president of the 46th Annual Meeting of the Japanese Society of Pediatric Neurosurgery in 2018. In October 2018, he joined Kitasato University School of Medicine to establish the Division of Pediatric Neurosurgery. He co-chaired the 4th Congress of the Asian-Australasian Society of Pediatric Neurosurgery in 2023.Dr. Morota is recognized for introducing functional posterior rhizotomy for children with spasticity in Japan and promoting its adoption nationwide. His clinical expertise spans a wide range of areas, including craniovertebral junction surgery, deep-seated brain and brainstem tumors, lumbosacral congenital anomalies, neuroendoscopic surgery, spasticity, and intraoperative neurophysiology. Dr. Paul Steinbok obtained his medical training at the University of the West Indies in Jamaica. This was followed by an internship in Toronto and a residency in neurosurgery in Vancouver at UBC.  He practiced as a neurosurgeon in Vancouver since March 1979. In 1985 he became Head of Neurosurgery at BC Children’s Hospital and limited his practice to pediatric neurosurgery. Dr. Steinbok is recognized internationally as a leader in pediatric neurosurgery. A major area of clinical interest has been the surgical treatment of children with spastic cerebral palsy and he is acknowledged as an international expert in this field. He has particular expertise in the surgical procedure of selective dorsal (posterior) rhizotomy and has done over 250 such procedures, initially via multilevel laminectomies but more recently using a less invasive single level laminectomy approach. He was the first to do this procedure in Canada in 1987 and has published many scientific articles on this subject. Academically, Dr. Steinbok is a full Professor at the University of British Columbia, in the Department of Surgery. He has taken a major interest in the education of neurosurgeons in the field of pediatric neurosurgery and has organized and participated as teaching faculty in many international pediatric neurosurgery courses around the world, with over 200 presentations at such courses. Dr. Steinbok has returned to Jamaica to initiate a successful neuroendoscopy program at the University Hospital of the West Indies and has assisted the neurosurgeons in Jamaica and Barbados in complex pediatric neurosurgical cases.”

• Introduction.- History of Dorsal Rhizotomy for Spasticity.- Neurophysiological and Neuroanatomical Background of Spasticity. Surgical implication for Dorsal Rhizotomy in Cerebral Palsy.- Role of dorsal rhizotomy in the comprehensive management of childhood spasticity.- Creating a Selective Dorsal Rhizotomy team.- Selection of children with spasticity other than cerebral palsy- Indications, long-term outcome, and exclusion criteria.- Preoperative Assessments for Selective Dorsal Rhizotomy.- Rhizotomy surgery at the conus medullaris.- Cauda equina level Selective Dorsal Rhizotomy.- Rootlet Selection by Crescendo Single-pulse Evoked Compound Muscle Action Potential Interpretation During Selective Dorsal Rhizotomy.- Dorsal Rhizotomy at the Intradural Juxtaforaminal Zone.- Selective dorsal rhizotomy: what, when and why to cut.- Functional posterior rhizotomy with the use of intraoperative neurophysiology.- Postoperative functional recovery and rehabilitation following Selective Dorsal Rhizotomy.- LONG-TERM OUTCOME OF SELECTIVE DORSAL RHIZOTOMY FOR SPASTIC CHILDREN.- Patient Selection in Selective Dorsal Rhizotomy (SDR).- Start-up of Rhizotomy Program in a Developing Country.- New developments in the surgery for spasticity.