This site provides up-to-date information about selective dorsal rhizotomy (SDR), an accepted method for treatment of spastic cerebral palsy (CP). It also includes recommendations from the Center for Cerebral Palsy Spasticity at the St. Louis Children's Hospital.
The content of this web site is based on medical literature and our own experience. Since its inception in 1987, Dr. Park has performed SDR on more than 1,600 children and adults for treatment of CP spasticity. Parents and patients with CP need to be fully informed of all options, including SDR. It is our hope that the information here will help you make the best possible decisions for your children if you are parents and for yourself if you are an adult with CP.
Most Experienced in the World
- We have over 20 years experience performing selective dorsal rhizotomies with unequalled knowledge of post-surgical outcomes.
- We have performed over 1,650 surgeries, with no major complications, on children and adults from 46 states and 36 countries.
- We have published over 40 scientific articles on rhizotomy.
Cerebral Palsy
Cause of Spasticity
Prevalence of Spasticity
Effects of Spasticity
Current Treatments for CP Spasticity
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Cerebral Palsy
CP affects movement and posture and is caused by brain damage before, during, or after birth. The brain damage underlying CP cannot be reversed and produces life-long disabilities. Despite remarkable medical advances, the incidence of CP has not decreased, with one out of 500 children being afflicted with the disorder.
Treatment of CP varies with the age of patients, and many options are available. Deciding among options can be difficult for parents who are making medical decisions for their children. It is important for parents and patients to consult with their treatment team, which includes physical therapist, pediatrician, rehabilitation medicine specialist (physiatrist), neurologist, neurosurgeon and orthopaedic surgeon. Also, medical literature and the information given here can be helpful.
Cause of Spasticity
Spasticity refers to increased tone, or tension, in a muscle. Normally, muscles must have enough tone to maintain posture or movement against the force of gravity while at the same time providing flexibility and speed of movement. The command to tense, or increase muscle tone, goes to the spinal cord via nerves from the muscle itself. Since these nerves tell the spinal cord just how much tone the muscle has, they are called "sensory nerve fibers." The command to be flexible, or reduce muscle tone, comes to the spinal cord from nerves in the brain. These two commands must be well coordinated in the spinal cord for muscles to work smoothly and easily while maintaining strength.
In a person with CP, damage to the brain has occurred. For reasons that are still unclear, the damage tends to be in the area of the brain that controls muscle tone and movement of the arms and legs. The brain of the individual with CP is therefore unable to influence the amount of flexibility a muscle should have. The command from the muscle itself dominates the spinal cord and, as a result, the muscle is too tense, or spastic.
Prevalence of Spasticity
Approximately 80 out of 100 patients with CP have varying degrees of spasticity. Spasticity can be associated with diplegic, quadriplegic or hemiplegic CP. Spasticity can be evident during the first year of life in relatively severe CP, but most often it is detected later. It is important to note that once spasticity has developed with CP, it never resolves spontaneousy.
Effects of Spasticity
There is no way in which spasticity is of benefit to children or adults with CP. Spasticity adversely affects muscles and joints of the extremities, causing abnormal movements, and is especially harmful in growing children. The known adverse effects of spasticity include:
- Inhibition of movement.
- Inhibition of longitudinal muscle growth.
- Inhibition of protein synthesis in muscle cells.
- Limited stretching of muscles in daily activities.
- Development of muscle and joint deformities.
It is important to mention that patients with CP do not have deformities of the extremities at birth but develop them over time. Spasticity of muscles, along with the limitations on stretching and use of muscles in daily activities, is a major cause of deformities.
Current Treatments for CP Spasticity
Currently, oral medication, Botox (botulinum A toxin) injection, baclofen infusion, orthopaedic surgery, selective dorsal rhizotomy surgery, physical therapy, and braces are employed to treat CP spasticity and related problems.
Oral medications, such as valium and baclofen, are still tried, but the consensus is that they do not reduce spasticity.
Injections of Botox into muscles have been used widely in recent years. Botox weakens muscles for up to 3-4 months after injection, reducing spasticity in a limited group of muscles. Most important, the effect is only temporary. Side effects appear to be minimal.
Baclofen infusion, using a pump implanted in the abdominal wall, is clearly effective in reducing spasticity in spinal cord injury and can also reduce CP spasticity. However, baclofen infusion is not effective permanently; when it is stopped, spasticity recurs. Also, the baclofen infusion carries risks of overdose, meningitis, and other complications that may require repeated hospitalization, and since it has been used for CP for only several years, long-term consequences are not known.
Orthopaedic operations, including muscle release and tendon-lengthening procedures, are also used to treat deformities associated with spastic CP. Orthopaedic surgery certainly improves range of motion of the joints and makes it easier for children to move the lower extremities. A major side effect is permanent muscle weakness and resulting abnormal postures and deformities. Also, orthopaedic surgery does not reduce spasticity directly but treats only the consequences of spasticity.
Contact Us
The Center for Cerebral Palsy Spasticity
St. Louis Children's Hospital
One Children's Place
Room 4S20
St. Louis, Missouri 63110 USA
Phone -- 314.454.2813, or toll-free 800.416.9956
Fax -- 314.454.2818
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