SDR: A Surgical Procedure Designed to Help Child Walk

A young child with Cerebral Palsy has become a three-time internet sensation. For the past two Halloween holidays (2015 and 2016), the child has trick-or-treated in a costume that incorporated the walker the child needs in order to walk. Now, the child and his parents have recently received news that their young son has been approved to undergo a medical surgery that can change the child’s life forever. The procedure is called a selective dorsal rhizotomy, and the boy’s parents hope that it will enable their child to trick-or-treat next Halloween without the need for a walker or other assistive device. While it is true that a selective dorsal rhizotomy may be able to help this particular child walk again, it is not (unfortunately) a cure-all for all Cerebral Palsy children.

Description of and Screening for Selective Dorsal Rhizotomy

Nerves located in the spinal cord control the movement of muscles associated with walking, gait, and posture. In many forms of Cerebral Palsy, these muscles may experience spasticity, or a constant state of contraction. This leads to muscle stiffness, difficulty in walking, and can (over time) lead to bone deformities and joint troubles. Selective dorsal rhizotomy is a surgical procedure that results in certain nerve fibers causing the spasticity to be severed. This, in turn, can improve the ability of a child with Cerebral Palsy to walk unassisted.

To accomplish this, surgeons separate the nerves located in the lower spinal cord and, using electric stimulation, identify those sensory nerve rootlets that are responsible for causing the increased muscle tone. These sensory nerve rootlets are then severed, which should cause a decrease in spasticity in the lower limbs without compromising other functionality.

This procedure is not for everyone, however. Only children who pass a rather rigorous screening test. Children who meet the following requirements are generally considered to be good candidates for the selective dorsal rhizotomy procedure:

  • First, children who are between the ages of three and ten years are considered prime candidates for the procedure (although in certain cases older children may be considered for the procedure);
  • Next, children who have spasticity in their legs (that is, children affected with spastic diplegia or spastic quadriplegia) are the children most likely to obtain benefit from the procedure. Although selective dorsal rhizotomy has resulted in some children gaining better control over their arm, head, and torso muscles, but the selective dorsal rhizotomy procedure is specifically designed to improve muscle tone in the leg muscles, not in other muscle groups (it is not clear why other muscle groups other than those in the legs may sometimes see improvement from selective dorsal rhizotomy);
  • Finally, there is significant follow-up therapy involved after selective dorsal rhizotomy. Therefore, children who are already participating in physical therapy and/or who have demonstrated an ability to follow instructions and cooperate in physical therapy are considered good candidates for the procedure.

What Happens After the Surgery

Selective dorsal rhizotomy usually takes about four hours, and children will generally remain in the hospital for five days following the procedure. Three days after the surgery, the child will begin with physical and occupational therapy sessions designed to stretch his or her muscles, increase his or her range of motion, and improve balance. Once the child is released from the hospital, the child will continue to participate in therapy sessions with a local physical therapist and/or occupational therapist. In addition, the child will return for follow-up appointments with the doctor who performed the procedure at approximately six weeks after the surgery, six months after the surgery, and then again every year.

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