Selective Dorsal Rhizotomy Interventions in the Treatment of Spasticity

What is Spasticity?

Spasticity is a progressive disorder caused by Cerebral Palsy (CP) in childhood and characterized by excessive contractions of muscle groups. As a result, the controlling influence of the brain, which has been damaged by CP, on the spinal cord is reduced. Furthermore, external stimuli create a vicious circle at the level of the spinal cord, leading to excessive muscle responses. At Liv Hospital Neurosurgery Clinic, Selective Dorsal Rhizotomy (SDR) (sensory nerve root cutting) interventions are successfully performed in the treatment of spasticity.


 

Which Muscles Suffer from Spasticity?

Although all muscle groups contract, some muscle groups have more spastic contractions. For example, adductor spasm in the thigh causes the thigh to contract inward and a typical sign of spasticity called shearing develops. Further contraction of the flexor muscle groups causes flexion of the leg and foot. This last condition is reflected in the clinic as walking on tiptoe. This has negative effects on the child in his/her development period. Gait gets impaired, mobility gets impaired, and after a while, structural limitations defined as contractures are observed in the joints.
 

What is Spastic Diplegia?

If spasticity is limited to the lower side only, this is Spastic Diplegia. Here the top is stable If mental functions are also preserved, this condition is relatively milder and more treatable than the others.
 

What is Spastic Quadriplegia?

Spastic quadriplegia is when all sides are involved. This is undoubtedly a more serious situation. Some children may also have impaired mental functioning.
 

What is Selective Dorsal Rhizotomy?

Selective Dorsal Rhizotomy (SDR) (sensory nerve root cutting) interventions are important in Neurosurgery's approach to the treatment of spasticity. In the SDR intervention, it is aimed to cut the dorsal, i.e. sensory nerve roots of each muscle group in certain proportions according to the severity of spasticity in that muscle group.
 

How is Selective Dorsal Rhizotomy Surgery Performed?

The fibers causing excessive contraction are identified by neuromonitoring and cut by a certain percentage, on average 50%. This causes a slight loss of sensation. However, relaxation is achieved by cutting the spastic vicious circle in the most harmless place. This procedure is done at the lumbar level. In spastic diplegic children, rhizotomy is performed bilaterally on 5 roots between L2-S1 levels. Suitable spastic children benefit greatly from SDR intervention. The resulting relaxation makes it possible to apply a much more effective physiotherapy. Because spasticity basically benefits a lot from physiotherapy. Physiotherapy is continuous and intensive.