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Surgical Procedure for Cerebral Palsy Offers Hope

Cerebral palsy surgery

If you know someone who has cerebral palsy, you may be familiar with the physical challenges associated with this congenital disease. Although there is no cure for cerebral palsy, one surgical procedure offers hope in the form of long-term functional benefits, as revealed in a new study.

Who can benefit from the surgery?

The surgical procedure is called selective dorsal rhizotomy (SDR), and it is appropriate for some individuals who have one of the three main forms of cerebral palsy. Those forms include:

  • Ataxic cerebral palsy characterized by challenges with depth perception, unsteady movement, and poor balance. This type of CP occurs in about 5 to 10 percent of cases.
  • Athetoid cerebral palsy, characterized by uncontrolled, involuntary movements that affect the hands feet, and legs, and sometimes the face or throat. About 10 to 20 percent of CP cases are this type
  • Spastic cerebral palsy, which causes stiffness and problems with movement. This is the form of CP that can respond to SDR, and it is also the most common type of the disease, occurring in about 70 to 80 percent of cases.

Some individuals with cerebral palsy have a combination of symptoms, typically athetoid and spasticity. An estimated one-half million children and adults in the United States have cerebral palsy.

What is selective dorsal rhizotomy?
During a selective dorsal rhizotomy, a surgeon makes a one to two-inch incision in the lower back and cuts selected sensory nerve fibers that enter the spinal cord from the muscles. This can allow the remaining nerves to perform better, which in turn can reduce spasticity and improve a patient’s ability to move and walk.

Improvements in a patient’s motor function are usually most evidence during the first six months postsurgery. In succeeding years, children may continue to show slow but steady improvements for up to 10 years of age, while adolescent and adults who undergo SDR may see more benefits for about two years after surgery.

According to St. Louis Children’s Hospital, which is one of several hospitals in the United States that offers the surgery, complications associated with SDR are possible but not common. Of the more than 2,300 patients at their facility, three experienced a spinal fluid leak that required surgery, and “there was no long-term complications in any of patients who underwent surgery as early as 1987.”

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New study on selective dorsal rhizotomy
In the Journal of Neurosurgery. Pediatrics, reviewers reported on the long-term outcomes of the surgical procedure of patients through adolescence and into early adulthood. They started with data from 102 patients who completed preoperative evaluations and reviewed postoperative results at 1, 5, 10, and 15 years, looking specifically at lower-limb muscle tone, motor function, and the ability to perform activities of daily living (ADLs).

The reviewers concluded that the benefits of selective dorsal rhizotomy lasted through the teenage years and into early adulthood. Benefits included not only improvements in muscle tone, gross motor function, and ADL performance, but also a reduced need for additional treatments such as orthopedic procedures or Botox injections, which have been shown to help cerebral palsy patients.

In fact, of 88 patients who provided complete records of orthopedic procedures and use of Botox, the reviewers found that 52 (59.1%) underwent SDR only, 25 (28.4%) required some orthopedic surgery to the lower extremities, and 11 (1.5%) had Botox injections in addition to SDR.

More on cerebral palsy
Children born with cerebral palsy can have a variety of health problems ranging from vision and hearing challenges, speech difficulties, learning disabilities, and issues with breathing, bladder, and bowel control. While the causes of the abnormal development or damage to the brain associated with cerebral palsy are not completely understood, experts believe they may be due to genetic disorders, infections, health problems of the woman during pregnancy, or other factors.

Some of those other factors can include prematurity, as the risk of cerebral palsy is greater among infants born early or who are of low birth weight. In addition, infants or toddlers who suffer brain damage associated with lead poisoning, meningitis, malnutrition, or shaken baby syndrome may develop cerebral palsy.

Although no cure for cerebral palsy has yet been discovered, there are a variety of treatments available. For individuals who have spastic cerebral palsy, selective dorsal rhizotomy is a treatment option that may improve quality of life.

Dudley RW et al. Long-term functional benefits of selective dorsal rhizotomy for spastic cerebral palsy. Journal of Neurosurgery. Pediatrics 2013 Aug; 12(2): 142-50
St. Louis Children’s Hospital

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