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.
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.
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:
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.
Motor disorders seen in cerebral palsy are often accompanied by:
Children with CP are classified into three main groups according to their clinical characteristics:
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;
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
Main Goals in the Treatment Approach of Spastic Cerebral Palsy Types
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.