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News Wednesday, March 01, 2017

Canadian families have access to selective dorsal rhizotomy in Canada

Decades of expertise at Shriners Hospitals for Children — Canada

Selective dorsal rhizotomy (SDR) is a surgical procedure used to treat spasticity in some children with spastic cerebral palsy. Cerebral palsy (CP) is a term used to describe various disorders of movement, muscle tone or posture. Caused by abnormal brain development or an injury that affects the part of the brain that controls motor activities, CP first appears before, during or soon after birth, and can affect a variety of muscles. Spastic cerebral palsy represents the type of CP that manifests increased muscle tension or tone; this increased tone makes the affected muscles very stiff and muscle movements appear spastic. Studies have shown that gross motor development in young people with spastic CP can plateau during childhood and may decline during adolescence. It is therefore essential to improve motor function early in these children and maintain any improvements in muscle function over time so that these children may become productive young adults.

"To ensure the best result for the child, Shriners Hospitals for Children — Canada and the Montreal Children's Hospital Selective Dorsal Rhizotomy Program has fairly strict criteria”, explains Jean-Pierre Farmer, M.D., C.M., F.R.C.S. (C), surgeon in chief and director of the neurosurgery division at the Montreal Children’s Hospital, McGill University Health Centre.

Selective dorsal rhizotomy is often performed in children with spastic CP to reduce muscle spasticity and to gain or improve their balance and ability to walk. During surgery, nerve fibers carrying sensory impulses from muscles to the dorsal side (the back) of the spinal cord are stimulated electronically at their rootlets to identify which ones are sending messages that induce an exaggerated tone and reflex state called spasticity. Selectively, the fibers that cause spasticity are then cut, leaving fibers that carry normal impulses alone. This is designed to diminish the spasticity of the muscle involved without injuring muscle function. The procedure has proved successful in selected patients.

In addition, no increase in scoliosis for children who undergo the procedure (scoliosis is a condition that can develop in all children with PC) has been observed. Shriners Hospitals for Children — Canada and the Montreal Children's Hospital treated over 300 patients from Quebec, Ontario, Atlantic Canada, Manitoba and Saskatchewan over the last 25 years. The results of studies of patients followed for nearly 15 years have been published. In 2013, a study showed that the positive effects of RDS last since they have been observed until the individual is a young adult. This study « Long-term functionale benefits of selective dorsal rhizotomy for spasticcerebral palsy. Clinical article» by Dr. Roy W.R. Dudley and colleagues, can be read in the Jounal of Neurosurgery: Pediatrics, May 2013.