Selective Dorsal Rhizotomy
Spastic Cerebral Palsy in Children and Its Neurosurgical Treatment:
1) What is Cerebral Palsy (CP)?
Cerebral palsy (CP) is a group of disorders that affect muscle tone or posture, causing
physical disability in a developing child. CP is caused by a non-progressive damage to a
developing brain in a baby, most often before his (her) birth.
Based on its severity, CP could be categorized into 5 grades (Figure-1).
Cerebral palsy (CP) is a group of disorders that affect muscle tone or posture, causing
physical disability in a developing child. CP is caused by a non-progressive damage to a
developing brain in a baby, most often before his (her) birth.
Based on its severity, CP could be categorized into 5 grades (Figure-1).
Figure-1: Gross Motor Function Classification System (GMFCS)
2) What Causes Spasticity in CP Children?
Spastic CP is the most common CP type (about 60~70%). Damage to the pyramidal tract,
leading to insufficient inhibitory output to the spinal cord is its main cause (Figure-2)
Figure-2: Normal and Abnormal Stretch Reflex
3) What is SDR?
Selective dorsal rhizotomy (SDR) is a surgical procedure to selectively cut some dorsal
nerve rootlets in spine in spastic CP children, in order to decrease spasticity mainly in their
lower limbs, thus, to improve their motor function after a post-SDR rehabilitation program
(Figure-3).
Figure-3: Dorsal Nerve Root Selection and Dorsal Nerve Root Rhizotomy
SDR performed via single-level approach is the least invasive surgical technique in SDR
family, which allows neurosurgeons to go to those spinal nerve roots through a tiny skin
opening about 3.5cm. Such approach 100% replies on the intra-operative neurophysiological
monitoring (Figure-4).
Figure-4: How our SDR is Performed
4) What should we do after SDR?
Spastic CP children are suggested to go through an intensive rehabilitation program for minimal 12 months after our SDR procedure, to improve their motor function.
5) What could we expect for a spastic CP child after SDR followed by 2 years rehab program?
Based on our follow-up data, about 45% of our cases with their GMFCS level 2-4 before SDR surgery presented GMFCS level improvement after 2 years rehabilitation program. When using GMFM-66 to evaluate these cases, improvement of score varied from 0.67 to 15.31 with an average of 9.3.
Our SDR Team: Our team modified EMG interpretation method for SDR procedure, making our SDR safer, more effective, and universally applicable in all kinds of spastic CP cases, including very mild ones. Since the middle of 2016, our team have performed 450+ SDR cases with excellent results and zero complications.
Figure-5-6: Prof. Xiao Bo and Dr. Ido Strauss in the SDR surgery