Surgical Procedures for Spasticity in Cerebral Palsy
Part I
Selective dorsal rhizotomy is a nurosurgical procedure
that was first developed in the late 1800’s and early 1900's by a physician
in Africa. In selective dorsal the neurosurgeon makes a 2 to 3 inch incision
in the center of the lumbar region. Sensory and motor nerves are then accordingly
grouped. The surgeon then divides each of the dorsal sensory roots into
4-7 rootlets and stimulates each rootlet electrically. By examining electromyographic
(EMG) responses from muscles in the lower extremities, the surgical team
identifies the rootlets that cause spasticity. The abnormal rootlets are
selectively cut, leaving the normal rootlets intact. This reduces messages
from the muscle, resulting in a better balance of activities of nerve cells
in the spinal cord, and thus reduces
spasticity. Only those with spastic cerebral palsy
can benefit form this procedure. SDR should not be considered if the patient
has athetoid involvement. The recovery time from SDR can be anywhere from
6 months to 1 year or more and results can not be guaranteed. Intensive
physical therapy is required during recovery. The typical postoperative
treatment for SDR procedures includes IV Morphine given based on pain scores.
This allows for physical rehabilitation efforts to begin almost immediately.
Efforts are directed foremost on the goal of strengthening. Many people
find that they never fully recovered from SDR procedures, and many people
have experienced very bad outcomes as a result of SDR. Possible complications
of selective dorsal rhiziotomy include: Paralization of the lower extremities,
incontence, loss of bowle control, sensory loss, meningitis, as well as
wound infection. Currently it is felt by many with
cerebral palsy that SDR is done to often, without taking the long term out
comes into consideration, and for the wrong reasons. While in some cases
SDR can lead to increased flexibility and mussel control the ends may not
be worth the means. Most of the gains from SDR will be short term (3-5 years)
and will be lost eventually after a number of years (10+). This has lead
to a number of children having repeat SDRs and missing even more school
and social life than is required when only one SDR is done. Advocates of
this procedure claim that in some cases when done early it can reduce the
need for orthopedic surgical intervention however for many some orthopedic
surgical intervention will still be required. Adults who have cerebral palsy
have also speculated that the amount of physical therapy required after
a surgical procedure like SDR may be one of the factors that results in
the faster aging process experienced by adults
with cerebral palsy.
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Selective Dorsal Rhizotomy for Healthcare Professionals American Academy of Cerebral Palsy and Developmental Medicine SDR Symposium St. Louis Children’s Hospital Center for Cerebral Palsy Spasticity United Cerebral Palsy Association Inc. -SDR information and debate |
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1995-2000 page contents by Anee Stanford This page was last updated 06/18/00 |
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