Selective Dorsal Rhizotomy (SDR) Surgery for Cerebral Palsy - ACIBADEM
Selective Dorsal Rhizotomy (SDR) Surgery for Cerebral Palsy

Selective Dorsal Rhizotomy (SDR) Surgery for Cerebral Palsy

Cerebral palsy (CP) is a neurological condition that affects a person’s ability to move and coordinate their body. It results from damage to the developing brain and affects individuals throughout their lives. Many children with cerebral palsy are totally dependent on their family or caregivers physically. Selective dorsal rhizotomy (SDR) is one of the treatment options that can lead to improve movement for many children. SDR surgery may provide a better life quality and more independence for children with CP.

What is cerebral palsy?

Cerebral palsy is a specific set of neurological disorders. It affects movement, posture, and cognitive abilities due to brain damage. CP is a permanent, non-progressive disorder occurring in the brain before, during, or after birth. The incidence of CP has been reported as 4.4 per 1,000 newborns.

What causes cerebral palsy?

CP is usually caused by damage to the brain before birth, at birth, or in the neonatal period. What causes cerebral palsy? Some risk factors include:

  • Premature birth (before the 32nd week)
  • Inability to get enough oxygen
  • Low birth weight (<2500 g)
  • Cerebral hemorrhage (in the womb or after birth)
  • Infections
  • Genetic and metabolic disorders

What are the symptoms of cerebral palsy?

Cerebral palsy symptoms are about movement and development problems in children. Symptoms may differ depending on the age of the patient and types of cerebral palsy.

  • Hypotonia (excessive laxity): The baby’s arm and leg movements are very limited and the baby cannot move voluntarily.
  • Spasticity: One of the most common cerebral palsy symptoms is spasticity. 60% of children with CP have spasticity meaning stiff, tightened, involuntarily, and permanently contracted muscles. These children walk uncontrollably and with difficulty. This situation is usually noticed at 5-6 months of age.
  • Delay in developmental stages: If the baby cannot lift his head while lying face down at the age of two months, if the baby cannot hold his head upright at the age of four months, if the baby cannot turn over at the sixth month, if the baby cannot sit without support at the age of eight months, if the baby has a right-left preference before the 18th month, if the baby cannot walk independently at the age of 18 months, this situation needs to be questioned in detail.

Motor disorders seen in cerebral palsy are often accompanied by:

  • Sensory and perceptual disorders
  • Cognitive issues
  • Communication difficulties
  • Behavioral problems
  • Epilepsy
  • Secondary musculoskeletal system problems

What are the different types of cerebral palsy?

Children with CP are classified into three main groups according to their clinical characteristics:

  • Spastic: The primary problem is spasticity (hardness in muscle consistency). Impacts are divided into different groups according to their regions.
  • Dyskinetic: Involuntary movements such as turning and twisting are observed. For this reason, the desired movements cannot be performed properly.
  • Mixed: This is the group in which both spastic and dyskinetic movements are observed.

How is cerebral palsy diagnosed?

Cerebral Palsy or high risk of cerebral palsy can be accurately predicted as early as 6 months of age based on corrected age. Three tools with the best prognostic validity for detecting Cerebral Palsy before six months corrected age;

  • Evaluation of General Movements-Prechtl Analysis (GMs)
  • Magnetic resonance imaging (MRI)
  • Hammersmith Infant Neurological Examination (HINE)

What is the treatment of Cerebral Palsy?

For many years, the only treatment used was physical medicine and rehabilitation for cerebral palsy. Today, with advancements in cerebral palsy treatments, surgical interventions to treat spasticity may be possible. Botulinum toxin injection, an invasive procedure, is one of them. It may be used to block spasticity in a limited area in CP. However, botulinum toxin injection may be insufficient in the management of generalized spasticity. Selective dorsal rhizotomy (SDR) and intrathecal baclofen pump (ITB) surgery are frequently preferred. Pallidotomy surgery is also performed in severe cases. If botulinum toxin is insufficient for managing localized spasticity, selective neurotomy may be preferred.

Rehabilitation is one of the most crucial parts within cerebral palsy treatments. To maximize the benefits from neuroplasticity, a physiotherapy program should begin as early as possible. Regardless of the specific treatment procedure applied, physiotherapy and rehabilitation support should continue afterward. However, the clinical picture of every child with CP is not the same, and neither is the rehabilitation program the same.

Therefore, determining the goals of rehabilitation within the cerebral palsy treatment plan is crucial. The rehabilitation program should be designed based on the specific types of cerebral palsy.

Main Goals in the Treatment Approach of Dyskinetic Cerebral Palsy Types

  • Reducing involuntary movements
  • Increasing stabilization
  • Gaining midline orientation

Main Goals in the Treatment Approach of Spastic Cerebral Palsy Types

  • Supporting active movement
  • Experiencing the movement
  • Regulating spasticity

How is Cerebral palsy treatment? Selective Dorsal Rhizotomy (SDR) surgery

Selective dorsal rhizotomy (SDR) is one of the options that can lead to improved movement in many children suffering from spasticity. It is a surgery performed on the lower spinal cord to reduce spasticity or high muscle tone.

What you need to know about Selective Dorsal Rhizotomy (SDR) surgery

Selective dorsal rhizotomy surgery improves reception by clearing the communication lines between the body’s spinal cord nerves and muscles, which helps decrease muscle tone and stiffness. Thus, children with cerebral palsy may have a better life and more independence. However, there are a handful of centers offering SDR treatment to these children around the world. In Türkiye, Acıbadem’s Pediatric Neurosurgery team has intense experience in SDR with over 1000 surgeries.

What is selective dorsal rhizotomy (SDR)?

SDR is a procedure in which the spinal sensory nerves that cause spasticity are disabled. In this surgery, selected spinal sensory nerve rootlets are irreversibly disabled, reducing sensory input and resulting in a decrease in spasticity.

How does selective dorsal rhizotomy work?

Selective dorsal rhizotomy involves cutting a portion of the dorsal roots of spinal nerves to relieve the spinal column and reduce high muscle tone. Thus, muscle stiffness may subside in the patient. During the operation, intraoperative neuromonitoring is used, which is a crucial part of SDR surgery. It allows for the precise identification and targeting of specific nerve fibers responsible for spasticity, while minimizing the risk of injuring healthy nerves and muscles.

What are procedure details for selective dorsal rhizotomy?

SDR is a unique surgical procedure performed in the lower back region by pediatric neurosurgeons to diminish spasticity. It helps reduce overactive spinal reflexes and ease muscle spasticity by clipping the dorsal sensory nerves that send abnormal signals to the muscles.

What are the benefits of selective dorsal rhizotomy (SDR)?

Not all patients with cerebral palsy are good candidates for SDR surgery. However, for those who are suitable, the surgery can offer several benefits, including:

  • Diminishing spasticity
  • Reducing high muscle tone and stiffness
  • Improving the quality of life and independence
  • Enhancing movement
  • Better balance
  • Less pain
  • Improving fine motor skills, speech, and even voice volume
  • Increased confidence, social engagement, and articulation

What is the best age for SDR surgery?

Early surgery is important to prevent further neurological deterioration in children. When Selective Dorsal Rhizotomy (SDR) is performed on children between the ages of 3 and 6, better outcomes are observed.

What is the success rate of SDR surgery

If a child is a good candidate for SDR, after the surgery, it is highly likely to see improvements in the quality of walking, standing, sitting, and balance. They may also experience a marked reduction in muscle and joint pain.

How much does selective dorsal rhizotomy (SDR) surgery cost?

The exact cost of CP treatment varies depending on the specific condition and the treatment plan. However, Acıbadem International Patient Center is happy to discuss your situation and provide a personalized cost estimate.

Selective dorsal rhizotomy (SDR) Surgery in Turkey

In Türkiye, Acıbadem Pediatric Neurosurgery Team is the pioneer of SDR surgery. At Acıbadem, a pediatric neurosurgery team led by Professor Memet Özek focuses merely on the diagnosis and treatment of pediatric patients. The team has been performing SDR surgery for more than 30 years, benefiting over 1100 children thus far.

Why Acıbadem for Treatment?

Applying cerebral palsy treatments requires a multidisciplinary team. At Acıbadem, the whole process is meticulously planned, executed, and supervised by a multidisciplinary team including pediatric neurosurgery, orthopedics, pediatric neurology, and physiotherapy, collaborate to devise the most optimal treatment strategy for each patient.

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