Is Selective Dorsal Rhizotomy Suitable for Your Child’s Cerebral Palsy

Cerebral palsy (CP) is a condition caused due to an injury to the brain before, during or after birth, which leads to impairment in control and movement. Children diagnosed with cerebral palsy face difficulties in controlling muscles and movements as they grow and develop.

What is Selective Dorsal Rhizotomy (SDR) Surgery?

Children suffering from cerebral palsy have spasticity in their lower limbs (spastic diplegia or diparesis) which results in muscular stiffness and pain. Spasticity occurs when the brain sends abnormal signals to the muscles.

A surgical procedure called selective dorsal rhizotomy (SDR) helps children suffering from lower limb spasticity due to cerebral palsy. SDR helps in reducing the lower limb spasticity by decreasing the number of abnormal signals. SDR procedure is not a cure for cerebral palsy but the surgery helps in reducing muscle stiffness.

Selective dorsal rhizotomy (SDR) surgery is an irreversible procedure and the changes caused due to it cannot be undone. Selective dorsal rhizotomy (SDR) surgery is a 4 to 5-hour procedure and involves the following:

An incision into the upper lumbar spine
Identification of the lower end of the spinal cord with the help of an ultrasound prod
Opening of the membrane covering the spinal cord, and the lower end of the cord with the help of an operating microscope
Identification of the sensory roots entering the lower end of the spinal cord with the help of an operating microscope
Division of the sensory nerve roots into four or five rootlets
Stimulation of the rootlets for identifying the ones responsible for spasticity
Division of rootlets – the process is repeated for all the other nerve roots located on both sides, aiming to divide 50 to 70 percent of the sensory roots
Closure of the spinal cord membrane
Returning back of the muscles present in the back to their original position and closure of the skin with dissolvable stitches

Which Candidates are Suitable for Selective Dorsal Rhizotomy (SDR)?

Children belonging to the age groups of 3 to 10 years are the most suitable candidates for cerebral palsy, however, sometimes the older children may be suitable candidates as well. Children who are good at understanding and following directions and have a cooperative spirit are generally considered as ideal candidates for selective dorsal rhizotomy (SDR) procedure, as this procedure involves intensive follow-up therapy.

Researchers suggest that children between the age groups of 4 to 8 years with typical spastic diplegia will most benefit from selective dorsal rhizotomy (SDR) procedure. Besides, these children should also have:

High level of spasticity in multiple muscles of both legs
Spasticity that may affect their walking
Tried many other treatments like botulinum toxin, casting, orthoses and have not received any sufficient positive improvement with these alone
No abnormality of basal ganglia on MRI examination
An active mode of mobility such as crawling or walking with or without an assistive device
An ability to stand up and support their body
An ability to hold their posture against gravity and walk
Periventricular leucomalacia (PVL) because children having cerebral palsy due to PVL related to prematurity show a good response to SDR compared to cerebral palsy due to other reasons
Good cognitive development and motivation
Stability in their posture
No fixed contractures i.e., permanent inability to move joints through a normal range of motion

Adults with cerebral palsy are considered as ideal candidates for SDR under the following conditions:

If they are diagnosed with spastic diplegia
If they have no fixed deformity or mild fixed deformities
If they are highly motivated towards attending the intensive physical therapy and performing home exercise program
If they have good muscle strength in the legs and trunk
If they show evidence of adequate motor control
If they have a history of delayed motor development
If they show adequate motivation and ability to cooperate in therapy

Check out other Trusted Resources on Cerebral Palsy

Which Cerebral Patients are not Ideal Candidates for Selective Dorsal Rhizotomy (SDR)?

All the patients with spastic cerebral palsy (CP) are not benefitted with selective dorsal rhizotomy (SDR), especially the ones who suffer from some other conditions. CP candidates considered to be non-ideal for SDR include the following:

Patients who have a history of any congenital brain infection like congenital hydrocephalus unrelated to premature birth, head trauma or familial disease
Patients suffering from severe scoliosis
Patients who have fewer chances of making functional gains after surgery
Patients who have mixed cerebral palsy with major rigidity or dystonia
Patients suffering from head trauma or having any familial disease (patients having a history of hereditary spastic diplegia are considered to be non-ideal for SDR)
Patients having significant athetosis (involuntary writhing movements of the fingers, hands, toes, feet, arms, and legs or ataxia (lack of voluntary coordination of muscle movements)
Patients who have an excessive weakness
Patients who have undergone any previous major orthopedic surgery
Patients having a significant fixed contracture

Advantages of SDR

SDR procedure has the following benefits:

It decreases the need for surgeries of the hips and lower extremities
Relieves the leg pain
Improves function and movement of the upper body
Improves sitting balance, longer stride length, and helps in easier walking
Improves the walking pattern of the child
Reduces the need for soft tissue surgery (muscle lengthening) in most of the cases

Complications Associated with SDR

Following may be some possible complications of SDR procedure:

Paralysis of the legs
Bladder paralysis
Impotence
Loss of sensation
Wound infection
Meningitis
Spinal fluid leakage through the wound
Development of spinal deformity
Disk protrusion
Spinal stenosis (an abnormal narrowing of the spinal canal, which can lead to neurological issues)