1) What is cerebral palsy (cerebral palsy)?

Cerebral palsy (cerebral palsy) is a group of disorders that affect muscle tone or posture, causing physical disorders in a developing child. The CPU is caused by non-progressive damage to the developing brain in a child, most often before his (her) birth.

According to the severity of the SR, it can be divided into 5 classes (Figure-1).

Figure 1: Motor Function Classification System (GMFCS)

1) What causes spasticity in children with CPUs?
Spastic CPU is the most common type of CPU (about 60 ~ 70%). Damage to the pyramidal tract, leading to insufficient braking output to the spinal cord, is its main cause (Figure-2)

Figure 2: Normal and abnormal stretching reflex

1) What is SDR?
Selective dorsal risotomy (SDR) is a surgical procedure that allows you to selectively cut some roots of the dorsal nerve in the spine in children with spastic CP in order to reduce spasticity mainly in the lower extremities, so as to improve their motor function after the rehabilitation program after SDR (Fig-3).

Figure 3: Selection of spinal nerve roots and risotomy of spinal nerve roots

SDR, carried out using a single-level approach, is the least invasive surgical technique in the SDR family, which allows neurosurgeons to pass to these spinal cord roots through a tiny skin opening of about 3.5 cm. This approach is 100% responsive to intraoperative neurophysiological monitoring (Fig. 4).

Figure 4: How our SDR is carried out

1) What should we do after the SDR?
Children with spastic CPUs are invited to undergo an intensive rehabilitation program for at least 12 months after the SDR procedure to improve their motor function.
2) What can be expected from a child with a spastic CPU after SDR followed by a rehabilitation program for 2 years?
Based on our subsequent data, about 45% of our patients with GMFCS 2-4 levels before SDR surgery showed an improvement in GMFCS levels after a 2-year rehabilitation program. When using GMFM-66 to assess these cases, the improvement in the assessment ranged from 0.67 to 15.31 with an average of 9.3.

Our SDR team: Our team has changed the EMG interpretation method for the SDR procedure, making our SDRs more secure, more efficient and universally applicable in all kinds of CPU spastic cases, including very easy ones. Since mid-2016, our team has performed more than 450 cases of SDRs with excellent results and without complications.