Intraspinal rhizotomy alone or in combination with excision of the
scarred conus medullaris distal to the level of the cord anomaly was used
in thirteen patients with myelomeningocele at the thoracolumbar level whose
care was complicated by recurrent deformity of the lower extremities that
was caused by persistent spasticity. When examined at an average follow-up
of 5.3 years, all patients were free of spasticity, had manageable lower
extremities, and were able to sit in a wheelchair with ease. Twelve
patients had no change in the status of the urinary tract, but one patient
noted an adverse change in urinary status with increased wetness between
intermittent catheterizations. Intraspinal rhizotomy alone or in
combination with distal cordectomy should be used only in patients with
congenital paraplegia in whom reflex motor activity has caused recurrent
deformity of the lower extremities that cannot be controlled by the use of
braces or operations on the lower extremities, or both.