Neurosurgery for Spasticity

The main operation on the nervous system that is used for the treatment of spasticity is called functional or selective dorsal rhizotomy (SDR). In this procedure, the neurosurgeon cuts nerve roots (rhizotomy)—the nerve fibers lying just outside the back bone (spinal column) that send sensory messages from the muscles to the spinal cord. Selective indicates that only certain nerve roots are cut, and dorsal means that the target nerve roots are those that lie at the back of the spinal cord (the upper surface when a person is lying on his or her stomach).

SDR is used to treat severe spasticity of the legs that interferes with movement or positioning. The best candidate for SDR is a person with good strength and balance, spasticity of one or both legs and not of the arms, little or no fixed contractures in the legs, and strong motivation and support.

SDR is performed with the patient under general anesthesia. Recovery usually includes one day in the intensive care unit and another week or so in the hospital after the operation. Limited physical therapy begins after 1 to 2 days, with activity increasing every day. The person who has had an SDR will usually need about 4 weeks to recover at home before returning to work or school.

The most serious complications after SDR include paralysis of the legs, bladder, or bowel; a leak of cerebrospinal fluid; or infection of the incision or of the covering of the brain and spinal cord (meningitis). Long-term complications may include low back pain, curvature of the spine, and hip displacement. It may be possible to reduce the likelihood of developing these long-term complications through appropriate physical therapy. Changes in how the SDR is performed have reduced the rate at which these complications occur.

	Orthopedic Operations