SELECTIVE
DORSAL
RHIZOTOMY
Surgical treatment of children with spastic cerebral palsy
Selective dorsal rhizotomy (SDR) is a surgical procedure that selectively cuts some of the roots of the dorsal nerve in the spine in children with spastic cerebral palsy, in order to reduce spasticity mainly in the lower extremities, so as to improve their motor function after a rehabilitation program after SDR.
Results after SDR
GMFCS LEVEL 1
Currently, SDR is the only surgical procedure that can ensure a constant reduction in spasticity in cerebral palsy in children.
GMFCS LEVEL 2
Selective dorsal rhizotomy reduces the severity of contractures of the hamstring tendon and heel rope. As a rule, there are improvements in tiptoe gait after SDR.
GMFCS LEVEL 3
Spasticity negatively affects the joints and muscles of the limbs, causing abnormal movements, is the main cause of limb deformities and is especially harmful in growing children.
GMFCS LEVEL 4
SDR surgery can help your child improve walking and range of movements, reduce spasticity. Facilitate a number of self-care activities.
Dear Parents,
I am Prof. Xiao Bo, a highly accomplished pediatric neurosurgeon who specializes in surgical treatments for all types of pediatric neurosurgical disorders, particularly those with spastic cerebral palsy. I hold board certifications in both China and Israel and am the Chief of Pediatric Neurosurgery Department and Director of the Cerebral Palsy and Spasticity Center at Shanghai Children's Medical Center in Shanghai, China, as well as the Chief of the Selective Dorsal Rhizotomy (SDR) Center at Dana-Dwek Children’s Hospital, Sourasky Medical Center in Tel Aviv, Israel.
With over a decade of experience in this field, I have dedicated myself to improving the surgical treatment outcomes for children with spastic cerebral palsy. My team and I have accumulated over 1 million pairs of input-output intraoperative neurophysiological data from lower spinal cords in patients with spastic cerebral palsy, leading to the establishment of the world's first human spinal nerve evoked-CMAP database. This database has provided new opportunities for optimizing SDR protocols and improving surgical treatment outcomes, as well as for further understanding the principles and modes of spinal cord networks in populations with spastic cerebral palsy.
In 2018, I developed a standardized intraoperative EMG interpretation scheme to guide SDR in a quantitative manner, which has been used in over 600 SDR procedures and has shown excellent outcomes. .......
Patients For SDR
Conditions for the SDR operation:
All types of patients with spastic cerebral palsy aged 4 to 14 years are good candidates for our SDR, including diplegy, quadriplegy, triplegy and hemiplegy, regardless of their preoperative level of GMFCS. (spasticity class).
The best age for our SDRs is from 4 to 14 years, the age we did is 16 years, the results are still good, but require a longer rehabilitation program.Since mid-2016, our team has completed more than 450 SDRs with excellent results and without complications.
SDR is the only surgical procedure that can ensure a constant reduction in spasticity in cerebral palsy in children. Improves the balance in the standing and walking position.
Selective dorsal rhizotomy reduces the severity of contractures of the hamstring tendon and heel rope. As a rule, there are improvements in tiptoe gait after SDR. Improves posture in a sitting and standing position.
SDR has a positive effect on the joints and muscles of the limbs, restoring normal movements, reduces deformity of limbs.After SDR surgery and 3-day bed rest in the hospital, the child needs an individual set of rehabilitation measures to restore. Most of this program is studied during the preoperative physiotherapy program and during hospital stay. Then parents are provided with specific types of activities and methods.
Publications
THE ROLE OF INTRAOPERATIVE NEURO-ELECTROPHYSIOLOGICAL MONITORING IN THE ONE-LEVEL APPROACH OF SELECTIVE DORSAL RISOTOMY.
TASK: Selective dorsal risotomy using a single-level approach (SL-SDR) for the treatment of spasticity is 100% based on the interpretation of the results of intraoperative neuroelectrophysiological monitoring. This study is devoted to the role that the interpretation of EMG plays during the SL-SDR procedure in the choice of nerve roots for partial dissection in pediatric cases with spastic cerebral palsy (cerebral palsy).
IS THE RECENTLY MODIFIED RISOTOMY PROTOCOL APPLICABLE TO GUIDE THE ONE-LEVEL SDR APPROACH FOR THE TREATMENT OF SPASTIC QUADRIPLEGIA AND DIPLEGIA IN CHILDREN WITH CEREBRAL PALSY?
GOAL: Our goal was to check whether the recently modified rhizotomy protocol that could be effectively used to guide selective dorsal rhizotomy (SL-SDR) of a single-level approach for the treatment of spastic hemiplegic cases, mainly releasing those spastic muscles (target muscles) noted before surgery, in their lower limbs were still applicable in cases of spastic quadriplegic or diplegic cerebral palsy (cerebral palsy) in the pediatric population.
ELECTROPHYSIOLOGY OF SENSITIVE AND MOTOR NERVE FIBERS IN SELECTIVE SPINAL RISOTOMY.
GOALS: Spasticity remains the main obstacle in the treatment of cerebral palsy (cerebral palsy). Single-level selective dorsal risotomy (SDR) is a minimally invasive intervention that reduces spasticity in individual patients. We provide a descriptive set of regulatory data that practitioners can use to manage a single-level SDR procedure, including (1) physiological thresholds used to separate the ventral section from dorsal roots; (2) characteristics of muscle reaction; (3) descriptions of abnormal physiological reactions; and (4) percentage of roots cut during surgery.
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