{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:46:35Z","timestamp":1770353195079,"version":"3.49.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"14","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Management of medically refractory limb-specific hypertonia is challenging. Neurosurgical options include deep brain stimulation, intrathecal baclofen, thalamotomy, pallidotomy, or rhizotomy. Cervical dorsal rhizotomy has been successful in the treatment of upper-extremity spasticity. Cervical ventral and cervical ventral-dorsal rhizotomy (VDR) has been used in the treatment or torticollis and traumatic hypertonia; however, the use of cervicothoracic VDR for the treatment of upper-extremity mixed hypertonia is not well described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 9-year-old girl with severe quadriplegic mixed hypertonia secondary to cerebral palsy (CP) underwent cervicothoracic VDR. Modified Ashworth Scale scores, provision of caregiving, and examination improved. Treatment was well tolerated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Cervicothoracic VDR can afford symptomatic and quality of life improvement in patients with medically refractory limb hypertonia. Intraoperative positioning and nuances in surgical techniques are particularly important based on spinal cord position as modified by scoliosis. Here, the first successful use of cervicothoracic VDR for the treatment of medically refractory upper-limb hypertonia in a pediatric patient with CP is described.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2438","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T15:15:34Z","timestamp":1711984534000},"source":"Crossref","is-referenced-by-count":4,"title":["Cervicothoracic ventral-dorsal rhizotomy for bilateral upper-extremity hypertonia in cerebral palsy: illustrative case"],"prefix":"10.3171","volume":"7","author":[{"given":"Ryan","family":"Kelly","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanna R","family":"Kemeny","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Feinberg School of Medicine Northwestern University, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunny","family":"Abdelmageed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Feinberg School of Medicine Northwestern University, Chicago, Illinois"},{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Trierweiler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois"},{"name":"Nuvasive Clinical Services, Columbia, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Krater","sequence":"additional","affiliation":[{"name":"Shirley Ryan AbilityLab, Chicago, Illinois; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa A","family":"LoPresti","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"},{"name":"Division of Pediatric Neurosurgery, Departments of Neurosurgery and Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey S","family":"Raskin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Feinberg School of Medicine Northwestern University, Chicago, Illinois"},{"name":"Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children\u2019s Hospital, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10","key":"b1","series-title":"J Neurol","first-page":"787","article-title":"A prevalence study of primary dystonia in eight European countries","volume":"247","year":"2000","unstructured":"Epidemiological Study of Dystonia in Europe (ESDE) Collaborative Group. A prevalence study of primary dystonia in eight European countries. J Neurol. 2000;247(10):787\u2013792."},{"issue":"3","key":"b2","series-title":"Dev Med Child Neurol","first-page":"252","article-title":"Diagnostic approach to paediatric movement disorders: a clinical practice guide","volume":"63","author":"Brandsma R","year":"2021","unstructured":"Brandsma R, van Egmond ME, Tijssen MAJ, Groningen Movement Disorder Expertise C. Diagnostic approach to paediatric movement disorders: a clinical practice guide. Dev Med Child Neurol. 2021;63(3):252\u2013258."},{"key":"b3","series-title":"Adv Neurol","first-page":"121","article-title":"The epidemiology of the primary dystonias in the north of England","volume":"78","author":"Duffey PO","year":"1998","unstructured":"Duffey PO, Butler AG, Hawthorne MR, Barnes MP. The epidemiology of the primary dystonias in the north of England. 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J Bone Joint Surg Am. 2012;94(17):1605\u20131609."},{"issue":"10","key":"b1","series-title":"J Neurol","first-page":"787","article-title":"A prevalence study of primary dystonia in eight European countries","volume":"247","year":"2000","unstructured":"Epidemiological Study of Dystonia in Europe (ESDE) Collaborative Group. A prevalence study of primary dystonia in eight European countries. J Neurol. 2000;247(10):787\u2013792."},{"issue":"3","key":"b2","series-title":"Dev Med Child Neurol","first-page":"252","article-title":"Diagnostic approach to paediatric movement disorders: a clinical practice guide","volume":"63","author":"Brandsma R","year":"2021","unstructured":"Brandsma R, van Egmond ME, Tijssen MAJ, Groningen Movement Disorder Expertise C. Diagnostic approach to paediatric movement disorders: a clinical practice guide. Dev Med Child Neurol. 2021;63(3):252\u2013258."},{"key":"b3","series-title":"Adv Neurol","first-page":"121","article-title":"The epidemiology of the primary dystonias in the north of England","volume":"78","author":"Duffey PO","year":"1998","unstructured":"Duffey PO, Butler AG, Hawthorne MR, Barnes MP. The epidemiology of the primary dystonias in the north of England. Adv Neurol. 1998;78:121\u2013125."},{"issue":"6","key":"b4","series-title":"Dev Med Child Neurol","first-page":"509","article-title":"An update on the prevalence of cerebral palsy: a systematic review and meta-analysis","volume":"55","author":"Oskoui M","year":"2013","unstructured":"Oskoui M, Coutinho F, Dykeman J, Jett\u00e9 N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013;55(6):509\u2013519."},{"issue":"4","key":"b5","series-title":"Clin Neuropharmacol","first-page":"276","article-title":"Baclofen in the treatment of dystonia","volume":"15","author":"Greene P","year":"1992","unstructured":"Greene P. Baclofen in the treatment of dystonia. Clin Neuropharmacol. 1992;15(4):276\u2013288."},{"issue":"2","key":"b6","series-title":"Mov Disord","first-page":"213","article-title":"Development of resistance to botulinum toxin type A in patients with torticollis","volume":"9","author":"Greene P","year":"1994","unstructured":"Greene P, Fahn S, Diamond B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord. 1994;9(2):213\u2013217."},{"issue":"1","key":"b7","series-title":"Mov Disord","first-page":"48","article-title":"Baclofen in the treatment of idiopathic dystonia in children","volume":"7","author":"Greene PE","year":"1992","unstructured":"Greene PE, Fahn S. 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Spine (Phila Pa 1976). 1989;14(7):717\u2013721."},{"issue":"12","key":"b19","series-title":"J Bone Joint Surg Am","first-page":"2349","article-title":"Correction of sagittal plane spinal deformities with unit rod instrumentation in children with cerebral palsy","volume":"85","author":"Lipton GE","year":"2003","unstructured":"Lipton GE, Letonoff EJ, Dabney KW, Miller F, McCarthy HC. Correction of sagittal plane spinal deformities with unit rod instrumentation in children with cerebral palsy. J Bone Joint Surg Am. 2003;85(12):2349\u20132357."},{"issue":"6","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"583","article-title":"Scoliosis in the institutionalized cerebral palsy population","volume":"6","author":"Madigan RR","year":"1981","unstructured":"Madigan RR, Wallace SL. Scoliosis in the institutionalized cerebral palsy population. 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