Offering a remedy for children with spasticity | Viewpoint

For children with spasticity, the nerves that signal muscles to contract turn on when a muscle is stretched. This results in tight and stiff muscles, limited mobility and pain, making it difficult to complete regular daily tasks like walking and getting dressed.

Jeffrey Leonard, MD

Spasticity is caused by cerebral palsy and other conditions that affect the brain and spinal cord. In addition to its effects on mobility, spasticity may also contribute to malformed joints, pressure ulcers, and decreased quality of life.

One advanced spinal procedure – selective dorsal rhizotomy (SDR) – offers a solution to daily challenges presented by spasticity. While SDR is considered very safe and effective, yielding an overall improvement in quality of life for kids, it is offered at few pediatric hospitals because only a handful of surgeons are experienced in the technique.

To perform SDR, a surgeon opens a small section of the spine, finds the group of nerve fibers causing the tense muscles and disconnects the nerves causing the most tightness. The procedure improves mobility, reduces pain and relieves lower-limb muscle spasticity in nearly every patient who has the procedure. In patients with cerebral palsy, SDR can also improve spasticity-associated toe walking.

Selective dorsal rhizotomy, guided by electrophysiological monitoring, has long been established as a safe procedure. As with every surgical procedure, there are risks involved. For SDR, the limited risks include patchy sensory loss, spinal fluid leak, bowel and bladder impairment and wound infections. These risks have been mitigated at our hospital by instituting clinical procedures and utilizing experienced, specialized staff for this procedure.

With a single SDR surgery, improvements can be permanent. For families who are so often going through other treatment options that require ongoing time and energy, this is a dramatic help.

No matter where a family chooses to go, I recommend all families ask questions of their hospital team. Shared decision making is essential to set up a patient and their family for success. Surgeons should educate patients and families about SDR and other options so that everyone can move forward together with confidence. The other two biggest keys to success are an experienced neurosurgeon who can perform the procedure and specialized rehabilitation afterward.

Some things families should look for and ask about include:

• Whether a child is a good fit for SDR or not;
• The possible improvements following surgery, and if those improvements could be permanent;
• Experience of a surgeon in the SDR procedure;
• Availability of inpatient rehabilitation;
• Involvement of physical therapy and what a therapy routine would be like;
• Alternatives to SDR surgery.

In my career, I’ve seen the power that SDR has to improve the quality of life for patients. I have been in this field long enough now that I’ve watched patients grow up, graduate and lead fulfilling lives, achieving dreams that were once out of reach.

Jeffrey Leonard, MD, chief of neurosurgery at Nationwide Children’s Hospital