The neurosurgical procedure selective dorsal rhizotomy (SDR) can provide permanent relief from spasticity. In this procedure, neurosurgeons disconnect abnormally functioning nerves from the spinal cord to halt the dysfunctional communication between the patient’s muscles and brain.
SDRis most often performed in younger pediatric patients. SDR can be an excellent treatment option for children who experience spasticity that comes from cerebral palsy. Some adults with spasticity are good candidates for SDR as well.
The procedure is most often offered to those patients who do not have contractures and who have good cognitive function and strength. SDR may be able to assist these patients in many areas, including:
SDR can also help patients who are not mobile—the surgery may be a good option to reduce pain and contractures and ease daily life.
Our surgical team uses minimally invasive techniques for SDRs. This minimizes the size of the incision and reduces not only recovery time, but also discomfort after surgery and the potential for complications.
The patient will have general anesthesia before the surgery begins. Because each patient’s spasticity is caused by dysfunction in different nerve rootlets, the first steps in the surgery are aimed at discovering which of these tiniest nerve fibers are responsible for sending confused signals. Then the surgeon will disable these fibers.
With the patient lying on his or her stomach, the neurosurgeon makes an incision of approximately 1.5 inches in length near the base of the spine to obtain access to a single level of the spine. After opening a window in the back of the spine, the doctor can reach the spinal canal—and, within it, the thecal sac.
The neurosurgeon then opens the sac, finds the necessary nerves and selects the sensory rootlets that need to be examined. Using an instrument that applies small electrical charges to each nerve rootlet, and in continuous conversation with the neurophysiologist and the occupational and physical therapists on the surgical team who provide feedback about muscle response, the surgeon is able to determine how effectively each sensory rootlet carries an electrical stimulus.
Once the team is sure which rootlets function properly and which do not, the surgeon cuts the sensory rootlets that have been causing spasticity, leaving normal rootlets undisturbed.
Finally, the neurosurgeon seals the thecal sac and the surgical incision.
You may have questions about the surgery itself, the therapy that will follow, what to expect from the surgery in the long term or other aspects of the procedure. You may want to bring a list of these questions to your appointments.
Please discuss with your surgeon anything your child takes—medication or other supplements. It may be necessary to stop taking these before surgery. Let your care team know of any allergies to food, latex or medications.
When you come to the hospital for the surgery, you will want to pack personal items, such as a toothbrush, for both the patient and the caregiver. Children also sometimes like to have favorite small toys or blankets. If you have any specific questions regarding the hospital stay, your care team is always available to provide more information.
It can be surprising for you or your child to find that muscles are not as strong after surgery as they may have seemed when they were affected by spasticity. With physical therapy, however, these muscles will develop strength and can gain new function.
How long will my child stay in the hospital?
Usually patients lie flat for one day after the SDR procedure and then remain in the hospital for another couple of days. Discharge is usually on the third day after surgery, at which time patients generally move to a facility that provides intensive rehabilitation.
Will my child need to take any special medications?
The neurosurgeon will prescribe medicine to treat pain and muscle spasms in the postoperative period.
Will my child need rehabilitation or physical therapy?
Yes, physical therapy after SDR is a crucial part of treatment. On the first day after surgery, patients only rest. The next two days in the hospital include visits from the physical therapists who have been part of your child’s medical team. Most children are also prescribed a few hours of therapy each day in the weeks immediately following the surgical procedure. This usually takes place at an inpatient facility dedicated to rehabilitation. Hospital staff will assist you in setting this up, if you wish.
Will my child have any long-term limitations due to selective dorsal rhizotomy?
No, you can anticipate that the procedure will continue to be helpful in the long term—its benefits should last a lifetime.
Dr. Richard Anderson specializes in selective dorsal rhizotomy for pediatric patients. He is available for second opinions as well.
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