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Selective Dorsal Rhizotomy for Severe Spasticity (5503)

Selective Dorsal Rhizotomy for Severe Spasticity (5503) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Pediatrics, Parenting


Selective Dorsal Rhizotomy for Severe Spasticity

What is Spasticity?
ξ Spasticity often occurs with brain or spinal cord injury.
ξ Spasticity is caused by a break in the messages sent from the brain through the spinal
ξ With a break in this messaging system, there is a lack of motor control and too much
motor response (spasticity).
ξ Usually, the brain tells the muscles to relax when they are too tight.
ξ With spasticity, the nerve pathways that control muscle movement are damaged. There is
increased muscle tone or muscle stiffness. Muscles do not move quickly and smoothly.
ξ Symptoms range from mild stiffness to severe, painful spasms.
ξ Sometimes, spasticity leads to muscle contractures and bone deformities.
ξ There is no cure for spasticity but there are ways to treat the effects.
ξ When oral medicines do not control the spasticity, a surgical choice is a selective dorsal

Selective Dorsal Rhizotomy
ξ The goal of selective dorsal rhizotomy is to increase comfort and movement, and prevent
muscle and bone deformities.
ξ A selective dorsal rhizotomy controls spasticity by cutting the dorsal nerves that cause an
abnormal response.
ξ The nerves that trigger normal response are left intact.
ξ 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:
ξ No spasticity or mild spasticity in the arms.
ξ Moderate to severe spasticity in the legs.
ξ Spasticity which interferes with diaper changing, bathing, and sleeping.
ξ Good leg strength.
ξ Enough tone in the neck and trunk.
ξ The ability to do the extra physical therapy after surgery.

How is my child assessed for the Selective Dorsal Rhizotomy?
Each child is assessed by a team of doctors, nurses, and therapists. This takes place in the
Spasticity and Movement Disorders Clinic 608-263-6420, option 3.
These images show 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.

Before Surgery
 You will need a physical exam, health review, and lab tests.
 Please stop aspirin and ibuprofen for two weeks before surgery. It is alright to use
acetaminophen (Tylenol®) if needed.
 You will wash with Sage clothes as instructed.
 You will receive a phone call the day before surgery telling you when to stop eating and
 Do not wear make-up, jewelry, or nail polish to surgery.

During 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.

After Surgery
 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 θ 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. (608) 263-6420, option 3
After hours, weekends, and holidays, call the paging operator (608) 262-0486.
If you live out of the area, call 1 (800) 323-8942.

Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 3/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5503