Selective Dorsal Rhizotomy for Severe Spasticity
What is Spasticity?
Spasticity often occurs in children with brain or spinal cord injury. Usually, messages easily travel between the muscles and the brain. The brain tells the muscles to relax when they are too tight. If the nerve pathways that control muscle movement are damaged, people have an increase in muscle tone or muscle stiffness. Their muscles do not move quickly and smoothly. The symptoms range from mild stiffness to severe, painful spasms. Sometimes, spasticity leads to muscle contractures and bone deformities. There is no cure for spasticity but there are ways to treat the effects.
When oral medicines do not control the spasticity, a surgical choice is a selective dorsal rhizotomy. The goal is to make your child more comfortable, able to move more easily, and prevent muscle and bone deformities.
The image on the first page shows a dorsal (sensory) nerve sending a message to the brain. Muscles send messages to the brain through nerves. When arm or leg muscles feel pain, touch, or are stretched, the sensory message travels up the spinal cord to the brain. The brain sends a motor message back down the spinal cord, through the motor nerve, telling the arms and legs what to do or how to move. Spasticity is thought to be caused by a break in the messages sent from the brain to the spinal cord. With a break in this messaging system, there is a lack of motor control and too much of a motor response (spasticity). A selective dorsal rhizotomy controls this problem by cutting the dorsal nerves that cause an abnormal response. The nerves that trigger normal response are left intact. The result is fewer spasms without a loss of feeling or movement in the arms or legs.
Who would be helped by a Selective Dorsal Rhizotomy?
Your child may be helped if he has
- No spasticity or mild spasticity in the arms.
- Moderate to severe spasticity in the legs.
- Spasticity which makes diaper changing, bathing, and sleeping harder to do.
- Good leg strength.
- Enough tone in the neck and trunk.
- The ability to do the extra physical therapy after surgery.
- Your child will see a doctor or a neurosurgery nurse practitioner for a physical exam, health review, and lab tests.
- Tylenol® is okay if needed. But, no aspirin, ibuprofen, Excedrin® or any other over-the-counter pain relievers for 2 weeks before surgery.
- Wash the night before and the morning of surgery with an antibacterial soap, such as Dial®. Rinse well. Do not use lotions, powder or perfumes.
- Do not let your child eat anything or drink any milk or juice with pulp after midnight the night before surgery.
- It is alright to drink clear liquids until 4 hours before surgery.
- Do not let your child wear make-up, jewelry, or nail polish to surgery.
A cut is made in your child’s lower back. The back part of the spinal bone is removed to allow access to the dorsal nerve roots. The surgeon divides these nerve roots into rootlets. Each rootlet is stimulated with an electrical impulse. The movement of the legs (motor response) is observed. The rootlets that cause too much muscle movement are cut. Since only some of the nerve rootlets are cut, your child will still have feeling in his legs. At the end of the surgery, the back part of the spinal bone is put back in place.
The entire procedure lasts 6 hours. During this time a catheter is placed in the spinal column so that pain medicine can go directly to the surgical site. This will stay in place to provide your child with pain relief for 2 – 3 days.
- Once your child is eating and drinking normally, the IV will be removed.
- Your child must lie flat for one to two days. He may log roll (lie on his sides, back, or abdomen), but may not sit up. This is to prevent a cerebral spinal fluid (CSF) leak from the incision.
- Your child will be in the hospital for 4 – 6 weeks after surgery for rehabilitation.
- Your child will need intense physical therapy (PT) for several months to retrain the muscles and make them strong.
- At first, your child may have a hard time walking.
- The full effect of the surgery will not be known for 6 to 9 months.
- Your child will be seen in the neurosurgery clinic 2 – 4 weeks after discharge.
When to Call
Call if you notice any of these symptoms.
- Redness, pain, or swelling of the skin at or near the incision site.
- Drainage from the incision.
- Fever greater than 101.5° F during the first six months.
- Recurring headaches.
- Nausea and vomiting.
- Stiff neck.
- Irritability or excess sleepiness.
Call your neurosurgeon or nurse with any questions.
Catie, RN Call (608) 262-2761
Lisa RN Call (608) 890-6942
After hours, weekends, and holidays, call the paging operator (608) 262-0486.
To schedule an appointment, call (608) 263-6420.
If you live out of the area, call 1 (800) 323-8942.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 11/23/2011
Copyright © 11/23/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5503
Print Health Fact For You