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The selective dorsal Rhizotomy is a neurosurgical procedure for
children who have difficulty walking.
It's typically for young children, perhaps 3 years to 12
years old, that have difficulty with walking with their legs.
They typically have increased muscle tone in their legs, and
that's referred to as spastic diplegia.
They typically have the potential to ambulate on
their own.
So they may be walking with a walker, or walking with canes,
or just with braces, and the idea is to help them
ambulate better, and for them to have better outcomes over all.
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So the best candidates are young children who have spastic
diplegia that are motivated and
capable of working with their therapist.
So those are typically kids that are two and a half or
three years old that are able to get through significant
therapy regiments, maybe a few hours a week at least.
It's ideal if the kids can realize that they're
doing the therapy and working on walking better for themselves.
So they need to do the therapy program because they wanna walk
better, not just because it's what mom or
dad asked them to do.
It's also helpful if they don't have many other medical
problems, and they're gonna be able to cooperate with
the intensive therapy regimen afterwards.
Typically we perform this surgery and then the children
need to receive very intensive physical therapy for
several weeks and often at least a few months afterwards.
We need to do both the surgery and
the therapy afterwards to retrain the brain.
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So the surgery itself involves a procedure under the microscope
in the operating room.
The children are completely asleep throughout the entire
procedure and it usually takes about three to four hours.
Under the microscope we make an incision in the spine and
expose the nerve roots at the very bottom of the spinal cord
after they've come off the spinal cord.
We select out the ones that are the dorsal sensory roots,
that control the feedback loop from the muscles back
into the spinal cord.
And under the microscope, we test those roots, and
divide them into little rootlets and
test those rootlets to find the most abnormal ones, and
then we cut a certain percentage of the most abnormal ones.
Then close everything up, and the children are usually in
the hospital for at least a few days.
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The best time to have the procedure is when a young child
is old enough to realize that they are perhaps walking
differently than their siblings or their peers and
they're motivated to learn to walk better.
Most of these children are very involved
in a therapy program already and the ideal time is to capture
them after they realize That if they work hard in therapy,
they can walk better and do better.
But before they get to be old enough, in grade school or
middle school, where they realize that they are perhaps
different, and that starts to have negative consequences.
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So we now have some excellent long-term studies from around
the world that demonstrate that children can
have excellent long-term results 10 or
even 20 years out from selective dorsal rhizotomy.
And that's our goal, is for
these kids that are having difficulty walking,
say before they're entering kindergarten, to have them in
the best place possible as they head off to college.
So our goal is to sort of reset a meter that controls the tone
in their legs and help them walk better.
We'd like to do it before they become teenagers typically and
sort of all of us have less plasticity in our brain when
we're older.
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We're very fortunate here at John Hopkins that we have
an excellent team approach to taking care of these children.
So we work closely with our colleagues in anesthesia and
pain management to help reduce the difficulties
around peri-operative period.
And then we work with our colleagues in neurology and
rehab and orthopedics to design the best individualized program
for each child.
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