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International Health - Centers of Excellence: Selective Dorsal Rhizotomy

Overview

Many children with cerebral palsy have spasticity that interferes with their development of walking and speed of movement. Spasticity is particularly harmful in growing children,Dr. Park smaller because it inhibits some muscle growth, causes muscle contractures and permanent orthopedic deformities. That is why it is important to reduce or eliminate spasticity at an early age, ideally between ages 2 and 6.

Until 15 years ago, spasticity in children with cerebral palsy was treated with physical therapy, bracing and orthopedic surgery. But over the last 15 years, a neurosurgical procedure, selective dorsal rhizotomy (SDR), has been shown to reduce spasticity and improve motor functions, including walking. This procedure isolates and severs the lumbosacral sensory nerve roots that cause the spasticity. When performed at an early age, the procedure can allow children to move more freely, as well as reduce the number of orthopedic operations patients might otherwise require.

Number of Procedures

Since 1987, more than 1000 children, teens and adults from around the world have undergone selective dorsal rhizotomy at St. Louis Children's Hospital. Today, more than 100 surgeries are performed annually - far more than any one in the world. Most importantly, virtually all patients benefitted from the surgery to a varying degree and none of them had postoperative complications.

Specialized Services - Best Candidates

Candidates for SDR are children who have spastic cerebral palsy after premature birth. Children with spastic diplegia or quadriplegia are the best candidates. Dr. Park also offers dorsal rhizotomy for adult patients. Adult candidates have slightly different criteria and considerations than children.

Key Physicians

T.S. Park, M.D. is one of a handful of doctors who championed the use of selective dorsal rhizotomy as a treatment for children with cerebral palsy spasticity. Dr. Park is chief of pediatric neurosurgery at St. Louis Children's Hospital, Shi H. Huang professor of neurosurgery at Washington University School of Medicine, and one of the United States' leading pediatric neurosurgeons. Dr. Park has frequently been listed as one of the "Best Doctors in America."

Dr. Park modified the technique in 1991 to perform the SDR procedure through a single L1 laminectomy instead of extensive lubrosacral laminectomy. The advantage of Dr. Park's technique in selective dorsal rhizotomy is greatly reduced risk of late spine deformities that can occur after SDR. He performed SDR using the refined techniques on more than 730 children and young adults. No patient has developed late spine deformities.

The Center for Cerebral Palsy Spasticity team provides coordinated screenings before and after surgery that involve staff members from neurosurgery, physical therapy and the Human Performance Laboratory as well as the patient's own referring physician, orthopedist and physical therapist. Patients with cerebral palsy spasticity who come to the Medical Center benefit from the most extensive experience with the SDR procedure and the latest technology.

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Copyright 2010 Washington University School of Medicine
Copyright 2010 Washington University School of Medicine