Selective dorsal rhizotomy performed by Dr Anthony JOUD and Pr. Marc SINDOU at the Paediatric Neurosurgery Department of the CHRU de Nancy.
Abnormal nerve responses are isolated and partially cut , using among other, straight bipolar probe and Nimbus i-Care device form INNOPSYS.
The Selective Dorsal Rhizotomy Procedure
Selective Dorsal Rhizotomy (SDR) involves sectioning of some of the sensory nerve fibers that come from the muscles and enter the spinal cord. Two groups of nerve roots leave the spinal cord and lie in the spinal canal. The ventral spinal roots send information to the muscle; the dorsal spinal roots transmit sensation from the muscle to the spinal cord.
At the time of the operation, the neurosurgeon divides each of the dorsal roots into 3-5 rootlets and stimulates each rootlet electrically. By examining electromyographic (EMG) responses from muscles in the lower extremities, the surgical team identifies the rootlets that cause spasticity. The abnormal rootlets are selectively cut, leaving the normal rootlets intact. This reduces messages from the muscle, resulting in a better balance of activities of nerve cells in the spinal cord, and thus reduces spasticity.
Advantages of SDR Technique Over Other Techniques
- Reduced risk of spinal deformities in later years
- Decreased post-rhizotomy motor weakness
- Reduced hip flexor spasticity by sectioning the first lumbar dorsal root
- Shorter-term, less intense back pain
- Earlier resumption of vigorous physical therapy