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Results after SDR

GMFCS Level 1

Currently, SDR is the only surgical procedure that can provide a permanent reduction in spasticity in cerebral palsy in children.

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GMFCS Level 2

Selective dorsal rhizotomy reduces the severity of the hamstring and calcaneus contractures. Typically, there is an improvement in gait on tiptoe after SDR.

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GMFCS Level 3

Spasticity adversely affects the joints and muscles of the limbs, causing abnormal movements, is the main cause of limb deformities and is especially harmful in growing children.

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GMFCS Level 4

Operation SDR can help your child improve walking and range of motion, reduce spasticity. Facilitates a number of actions for personal care.

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Patients for SDR

Preoperative Evaluation and Patient Selection for SDR

Conditions for an SDR operation:

All types of patients with spastic cerebral palsy from 4 to 14 years old are good candidates for our SDR, including diplegia, quadriplegia, triplegia and hemiplegia, regardless of their preoperative level of GMFCS. (spasticity class).
The best age for our SDR is from 4 to 14 years old, the age that we did is 16 years old, the results are still good, but require a longer rehabilitation program.

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Results after SDR

Since mid-2016, our team has completed more than 450 SDRs with excellent results and without complications.

SDR is the only surgical procedure that can provide a permanent reduction in spasticity in cerebral palsy in children. Improves balance in standing and walking.
Selective dorsal rhizotomy reduces the severity of the hamstring and calcaneus contractures. Typically, there is an improvement in gait on tiptoe after SDR. Improves posture while sitting and standing.
SDR has a positive effect on the joints and muscles of the limbs restoring normal movement, reduces deformation of the limbs. 

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Postoperative rehabilitation.

After an SDR operation and a 3-day bed rest in the hospital, the child needs an individual set of rehabilitation measures to restore. Most of this program is studied during the preoperative physiotherapy program and during the hospital stay. Next, parents are provided with specific types of activities and methods.

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Our SDR team

Our team changed the EMG interpretation method for the SDR procedure, making our SDR safer, more efficient, and universally applicable in all types of spastic CPU cases, including very light ones. Since mid-2016, our team has completed more than 450 SDRs with excellent results and without complications.

Professor
Xiao Bo

He is the head of the Department of Pediatric Neurosurgery and the Director of the Department of Surgical Muscle Tonus at Shanghai Children's Hospital

Professor
Shlomi Constantini

heads the Department of Neurosurgery at the Dana Pediatric Clinic, which is part of the Medical Center. Surasky (Ichilov) in Tel Aviv.

Dr.
Akiva Korn

He is Director of Surgical Neurophysiology at the Medical Center of Tel Aviv University, Israel.

Dr.
Ido Strauss

neurosurgeon, head of the department of pain treatment and stereotactic radiosurgery service in the department of neurosurgery of the MC Suraski (Ikhilov).

Coordinator
Yanina Markova

SDR International Program Coordinator

Publications

The role of intra-operative neuroelectrophysiological monitoring in single-level approach selective dorsal rhizotomy.

OBJECTIVE:

Selective dorsal rhizotomy via a single-level approach (SL-SDR) to treat spasticity 100% relies on the interpretation of results from the intra-operative neuroelectrophysiological monitoring. The current study is to investigate the role EMG interpretation plays during SL-SDR procedure with regard to the selection of nerve rootlets for partially sectioning in pediatric cases with spastic cerebral palsy (CP).

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Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?

PURPOSE:

Our aim was to test whether the newly modified rhizotomy protocol which could be effectively used to guide single-level approach selective dorsal rhizotomy (SL-SDR) to treat spastic hemiplegic cases by mainly releasing those spastic muscles (target muscles) marked pre-operatively in their lower limbs was still applicable in spastic quadriplegic or diplegic cerebral palsy (CP) cases in pediatric population.

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Electrophysiology of Sensory and Motor Nerve Root Fibers in Selective Dorsal Rhizotomies.

AIMS:

Spasticity remains a major impediment in the treatment of cerebral palsy (CP). The single-level selective dorsal rhizotomy (SDR) is a minimally invasive intervention that reduces spasticity in select patients. We provide a descriptive set of normative data that practitioners can utilize to help guide the single-level SDR procedure, including (1) physiological threshold values used to dissociate ventral from dorsal roots; (2) response characteristics of muscles; (3) descriptions of abnormal physiological responses; and (4) percentage of rootlets transected during surgery.

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