About the OperationAt present, Selective Dorsal Rhizotomy (SDR) is the only surgical procedure that can provide permanent reduction of spasticity in cerebral palsy. It results in improvements in sitting, standing, walking, and balance control in walking.
SDR involves cutting some of the sensory nerve fibers that come from the muscles and enter the spinal cord. One spinal root sends information to the muscle; and one spinal root transmits sensation from the muscle to the spinal cord.
In the operation, the neurosurgeon divides each of the roots that transmits sensation into 3-5 rootlets and stimulates each rootlet electrically. By examining the responses from muscles in the legs etc., the surgical team identifies the rootlets that cause spasticity. The abnormal rootlets are 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.
Different surgical techniques are utilized to perform SDR. Neurosurgeons typically perform SDR after removing the lamina from 5-7 vertebrae in order to expose the nerves. However, Dr. Park and his team were concerned about possible problems that can arise from removal of such a large amount of bone from the spine. They refined the technique and currently remove the lamina from a single vertebra.
The other layers of tissue and muscle etc. are sewn. The skin is closed with glue. There are no stitches to be removed from the back. Surgery takes approximately 4 hours. The patient goes to the recovery room for 1-2 hours before being transferred to the intensive care unit overnight.
Early SDR, at 2-4 years of age, can prevent the development of deformities. For this reason, we favor early surgery. Also, SDR will reduce deformities and makes it easier to treat deformities later with orthopaedic surgery.
For more in formation about SDR and the surgeons who perform it, you can take a look at the website of the St. Louis Children’s Hospital in Missouri.