{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T16:43:00Z","timestamp":1789231380652,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Objective: Neurosurgical interventions for medically refractory hypertonia (MRH) benefit both patients and their caregivers. Concurrent severe rotatory scoliosis and fusion constructs can make traditional microsurgical rhizotomy and navigated radiofrequency ablation (RFA) peripheral rhizotomy technically infeasible. We report the first case series of lumbosacral endoscopic ventral\u2013dorsal rhizotomy (eVDR) in patients with MRH, and highlight this novel, minimally invasive, safe, and effective technique. Material and Methods: We retrospectively reviewed our single institution series of four patients with advanced hypertonia, gross motor function classification scale (GMFCS) 5, and severe rotatory scoliosis who underwent an eVDR using a flexible endoscope. We report demographics, operative characteristics, and outcomes. Results: Four patients underwent bilateral L1-S1 eVDR. Two patients had spastic quadriplegia and two had mixed spastic and dystonic hypertonia. Mean operative time was 225 \u00b1 11 min and mean estimated blood loss (EBL) was 28.8 \u00b1 26.2 mLs. Average length of stay was 2.75 days (range = 1\u20135 days), and average follow-up was 5.75 months (range = 3\u20139 months). All patients had significant decrease in bilateral lower extremity modified Ashworth Scale (mAS) scores (median decrease = 3, interquartile range [IQR] = 1; Wilcoxon rank-sum test z = \u22122.3, p = 0.02). The median decrease in Barry\u2013Albright Dystonia Scale (BADS) scores for both patients with dystonia was 8 (IQR = 0). Two patients had minor perioperative events; none required additional surgery. All parents reported improvement in caregiving metrics. Conclusions: eVDR offers a safe and effective approach for tone reduction in patients with MRH and severe rotatory scoliosis and\/or fusion hardware, which disallows traditional approaches.<\/jats:p>","DOI":"10.3390\/brainsci15101030","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T08:19:45Z","timestamp":1758701985000},"page":"1030","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Lumbosacral Endoscopic Ventral\u2013Dorsal Rhizotomy: A Novel Approach for Tone Reduction"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6472-4441","authenticated-orcid":false,"given":"Lucinda T.","family":"Chiu","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL 60611, USA"},{"name":"Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7413-5974","authenticated-orcid":false,"given":"Benjamin E.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL 60611, USA"},{"name":"Northwestern University Feinberg Medical School, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9551-0123","authenticated-orcid":false,"given":"Nathan","family":"Pertsch","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Rush University Medical Center, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Rogers","sequence":"additional","affiliation":[{"name":"Globus Medical, Inc., Audubon, PA 19403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Katholi","sequence":"additional","affiliation":[{"name":"Department of Physiatry, Shirley Ryan Ability Lab, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1865-9888","authenticated-orcid":false,"given":"Jeffrey S.","family":"Raskin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL 60611, USA"},{"name":"Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1111\/dmcn.12080","article-title":"An update on the prevalence of cerebral palsy: A systematic review and meta-analysis","volume":"55","author":"Oskoui","year":"2013","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1111\/dmcn.15346","article-title":"Global prevalence of cerebral palsy: A systematic analysis","volume":"64","author":"McIntyre","year":"2022","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/ppe.12299","article-title":"Prevalence of Cerebral Palsy among 8-Year-Old Children in 2010 and Preliminary Evidence of Trends in Its Relationship to Low Birthweight","volume":"30","author":"Durkin","year":"2016","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S1474-4422(23)00004-2","article-title":"Towards functional improvement of motor disorders associated with cerebral palsy","volume":"22","author":"Bekteshi","year":"2023","journal-title":"Lancet Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.pmr.2014.09.003","article-title":"Scoliosis, Spinal Fusion, and Intrathecal Baclofen Pump Implantation","volume":"26","author":"Scannell","year":"2015","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/j.1469-8749.2009.03461.x","article-title":"Scoliosis in cerebral palsy","volume":"51","author":"Koop","year":"2009","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E708","DOI":"10.1097\/BRS.0b013e318246a962","article-title":"Scoliosis in a Total Population of Children with Cerebral Palsy","volume":"37","author":"Ma","year":"2012","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/jpc.15707","article-title":"Epidemiology of scoliosis in cerebral palsy: A population-based study at skeletal maturity","volume":"58","author":"Willoughby","year":"2022","journal-title":"J. Paediatr. Child Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2024.3.FOCUS2472","article-title":"Nonselective lumbosacral ventral-dorsal rhizotomy for the management of lower-limb hypertonia in nonambulatory children with cerebral palsy","volume":"56","author":"Abdelmageed","year":"2024","journal-title":"Neurosurg. Focus"},{"key":"ref_10","first-page":"324","article-title":"Combined ventral and dorsal rhizotomies for dystonic and spastic extremities","volume":"107","author":"Albright","year":"2007","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1097\/BPO.0000000000002878","article-title":"The Effect of Selective Dorsal Rhizotomy on Scoliosis in Children with Cerebral Palsy: A Long-term Follow-up Study","volume":"45","author":"Miller","year":"2025","journal-title":"J. Pediatr. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s00381-019-04375-x","article-title":"Systematic review of spinal deformities following multi-level selective dorsal rhizotomy","volume":"36","author":"Wheelwright","year":"2020","journal-title":"Childs Nerv. Syst."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102","DOI":"10.3171\/2020.6.PEDS20295","article-title":"Conus-level combined dorsal and ventral lumbar rhizotomy for treatment of mixed hypertonia: Technical note and complications","volume":"27","author":"Ahluwalia","year":"2020","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/2024.3.FOCUS2477","article-title":"Percutaneous thermal radiofrequency rhizotomy of L2\u2013S1 spinal nerve roots in children with cerebral palsy","volume":"56","author":"Shapkin","year":"2024","journal-title":"Neurosurg. Focus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1227\/ons.0000000000000860","article-title":"Navigated Radiofrequency Ablation Peripheral Rhizotomy for Lumbosacral Hypertonia in a Nonambulatory Patient with Spinal Fusion: Indications, Surgical Techniques, and Lessons Learned","volume":"25","author":"LoPresti","year":"2023","journal-title":"Oper. Neurosurg."},{"key":"ref_16","first-page":"1","article-title":"Novel Intradural Endoscopic Lumbosacral Ventral-Dorsal Rhizotomy: A Technical Note with Operative Video","volume":"00","author":"Richards","year":"2022","journal-title":"Oper. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1748-7161-1-2","article-title":"Adolescent idiopathic scoliosis: Natural history and long term treatment effects","volume":"1","author":"Asher","year":"2006","journal-title":"Scoliosis"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1001\/jama.2017.19342","article-title":"Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement","volume":"319","author":"Grossman","year":"2018","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1748-7161-3-16","article-title":"Vertebral rotation measurement: A summary and comparison of common radiographic and CT methods","volume":"3","author":"Lam","year":"2008","journal-title":"Scoliosis"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2106\/00004623-196951020-00002","article-title":"A Study of Vertebral Rotation","volume":"51","author":"Nash","year":"1969","journal-title":"J. Bone Jt. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"150","DOI":"10.2174\/1874325001711011500","article-title":"Imaging in the Diagnosis and Monitoring of Children with Idiopathic Scoliosis","volume":"11","author":"Ng","year":"2017","journal-title":"Open Orthop. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1227\/ons.0000000000001436","article-title":"Heterotopic Osteotomy for Intrathecal Baclofen Test Dose Administration in a Pediatric Patient with Spinal Fusion: A Technical Note","volume":"29","author":"Abdelmageed","year":"2024","journal-title":"Oper. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/CASE23217","article-title":"Pediatric intraspinal arachnoid cyst: Successful endoscopic fenestration. Illustrative case","volume":"6","author":"Horak","year":"2023","journal-title":"J. Neurosurg. Case Lessons"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"11","DOI":"10.5535\/arm.22108","article-title":"Effect of Intrathecal Baclofen Pump on Scoliosis in Children with Cerebral Palsy: A Meta-Analysis","volume":"47","author":"Lee","year":"2023","journal-title":"Ann. Rehabil. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1017\/S0012162201001190","article-title":"Intrathecal baclofen for generalized dystonia","volume":"43","author":"Albright","year":"2001","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_26","unstructured":"Shah, N., Di, N.R., and Padalia, D. (2025). Implantable Intrathecal Drug Delivery System. StatPearls, StatPearls Publishing."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s00701-020-04487-3","article-title":"Predictors of postoperative complications after selective dorsal rhizotomy","volume":"163","author":"Wach","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"487","DOI":"10.3171\/2009.6.PEDS0921","article-title":"Infections related to intrathecal baclofen therapy in children and adults: Frequency and risk factors","volume":"4","author":"Fjelstad","year":"2009","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s00381-025-06772-x","article-title":"Safety and efficacy of the novel subfascial with umbilicus detachment technique for intrathecal baclofen therapy in pediatric patients with cerebral palsy and low body mass index","volume":"41","author":"Costici","year":"2025","journal-title":"Childs Nerv. Syst."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"756","DOI":"10.3171\/2015.11.PEDS15421","article-title":"Risk factors for baclofen pump infection in children: A multivariate analysis","volume":"17","author":"Spader","year":"2016","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"395","DOI":"10.3171\/2017.10.PEDS17248","article-title":"A standardized protocol to reduce pediatric baclofen pump infections: A quality improvement initiative","volume":"21","author":"Desai","year":"2018","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"444","DOI":"10.3171\/2023.1.PEDS22368","article-title":"A multicenter initiative to reduce intrathecal baclofen pump surgical site infection: A Cerebral Palsy Research Network quality improvement project","volume":"31","author":"Bollo","year":"2023","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Westbom, L., Lundkvist, J.A., Wagner, P., and Nordmark, E. (2010). Growth in Children with Cerebral Palsy during five years after Selective Dorsal Rhizotomy: A practice-based study. BMC Neurol., 10.","DOI":"10.1186\/1471-2377-10-57"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1097\/BRS.0b013e31817bab42","article-title":"Baclofen pump implantation and spinal fusion in children: Techniques and complications","volume":"33","author":"Borowski","year":"2008","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"33","DOI":"10.14245\/ns.2346190.095","article-title":"Current Indications for Spinal Endoscopic Surgery and Potential for Future Expansion","volume":"20","author":"Chen","year":"2023","journal-title":"Neurospine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"476","DOI":"10.3171\/2008.7.17634","article-title":"Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: A prospective, randomized, controlled study","volume":"10","author":"Ruetten","year":"2009","journal-title":"J. Neurosurg. Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"335","DOI":"10.36076\/ppj.2013\/16\/335","article-title":"The current state of endoscopic disc surgery: Review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures","volume":"16","author":"Birkenmaier","year":"2013","journal-title":"Pain Physician"},{"key":"ref_38","first-page":"e22053","article-title":"Iatrogenic Spinal Deformity Following Spinal Intradural Arachnoid Cyst Fenestration Despite Minimal Access with Laminoplasty and Endoscopy in a Pediatric Patient","volume":"14","author":"Ordaz","year":"2022","journal-title":"Cureus."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3171\/2011.4.PEDS10533","article-title":"Intradural spinal endoscopy in children","volume":"8","author":"Chern","year":"2011","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e002381","DOI":"10.1136\/bmjpo-2023-002381","article-title":"Postoperative pain and pain management following selective dorsal rhizotomy","volume":"8","author":"Adams","year":"2024","journal-title":"BMJ Paediatr. Open"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1159\/000098382","article-title":"Selective Dorsal Rhizotomy and Postoperative Pain Management: A Worldwide Survey","volume":"43","author":"Hesselgard","year":"2007","journal-title":"Pediatr. Neurosurg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e60","DOI":"10.1016\/j.wneu.2018.12.187","article-title":"Surgical Outcomes of Single-Level Bilateral Selective Dorsal Rhizotomy for Spastic Diplegia in 150 Consecutive Patients","volume":"125","author":"Jeffery","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1159\/000028668","article-title":"Complications after Selective Posterior Rhizotomy for Spasticity in Children with Cerebral Palsy","volume":"28","author":"Steinbok","year":"1998","journal-title":"Pediatr. Neurosurg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"101425","DOI":"10.1016\/j.neuchi.2023.101425","article-title":"A systematic review of complications following selective dorsal rhizotomy in cerebral palsy","volume":"69","author":"Mishra","year":"2023","journal-title":"Neurochirurgie"},{"key":"ref_45","first-page":"754","article-title":"Responsiveness and minimal clinically important difference of Modified Ashworth Scale in patients with stroke","volume":"55","author":"Chen","year":"2019","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"673","DOI":"10.3171\/2023.7.PEDS22526","article-title":"Upper-extremity spasticity and functionality after selective dorsal rhizotomy for cerebral palsy: A systematic review","volume":"32","author":"Merckx","year":"2023","journal-title":"J. Neurosurg. Pediatr."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/10\/1030\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:28Z","timestamp":1760035708000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/10\/1030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["brainsci15101030"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15101030","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}