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Selective dorsal rhizotomy (SDR) is an operation for leg spasticity, a condition in which muscles are unusually rigid and limit leg movement.
A one-time spinal operation at Boston Children's Hospital can help some children with cerebral palsy and spastic diplegia walk independently. Learn more through the eyes of a family whose 4-year-old underwent the procedure.
The operation is an excellent option for some children with spastic cerebral palsy. After SDR, many children can transition from walkers to crutches or canes.
Why Boston Children's for Selective Dorsal Rhizotomy?
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For more information on SDR, please call 617-355-6008.
During SDR, a small incision is made in the back.
Sensory nerves bring sensations from the legs to the spinal cord. During the SDR surgery, doctors stimulate nerve rootlets, looking for abnormal muscle responses. The most abnormal nerve roots are cut.
©CATHERINE DELPHIA 2012
For muscles to work properly, they need to both contract and relax. But in children with spasticity, the signal to relax a muscle doesn’t get through. Instead, the sensory nerves keep telling the muscles they need to be tighter, so they contract even when they don’t need to. This results in the stiff gait and “scissoring” motion often seen in children with cerebral palsy.
SDR works by cutting the nerves that aren’t functioning properly.
During the surgery, Shenandoah Robinson, MD makes a small, inch-long incision in the lower back and removes a small section of bone to expose the nerve groups. A monitor attached to the patient’s legs measures electrical activity. Using a microscope, Dr. Shenandoah Robinson carefully stimulates each cluster of nerves and closely monitors muscle responses on a machine so that the correct nerves are targeted. The nerves that respond abnormally are cut.
SDR is performed under general anesthesia and normally takes about 4 hours. The surgery requires a stay in the hospital of 4 to 5 days.
Five-year-old Will DeMauvise had never been stopped by his cerebral palsy—in family videos, he swims, throws a baseball and drives a toy car. But Will walked with a “scissoring” motion, crossing one leg tightly over the other, and needed a walker. Injections of Botox® and phenol into Will’s legs helped, but the procedure required he go under anesthesia each time and the effect was short-lived.
When Will’s family learned about a one-time spinal operation called selective dorsal rhizotomy (SDR) at Boston Children’s, they brought him in to see Shenandoah Robinson, MD. He was at an age when SDR could help his muscles and limbs develop more normally. He was also determined and able to undertake the rigorous physical therapy that would be part of the follow-up treatment. Dr. Shenandoah Robinson quickly approved him for SDR.
After the surgery, Will was bearing weight on his legs within a week. He could climb stairs, and he didn’t scissor his legs anymore.
Like many children with cerebral palsy, Will experienced some weakness in his core after surgery. But intensive physical and occupational therapy, along with swimming and horseback riding, has started to turn that around. “Will realized quickly that he could do more things with his legs. He could see the progress and kept working harder and harder,” says Dr. Robinson.
Will entered kindergarten last fall with a long road ahead, but full of determination.
The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”