Cerebral palsy is a general term that describes a group of conditions that cause movement problems. The most common type is spastic cerebral palsy where the muscles are stiff and rigid in one or more limbs. The underlying problem is damage or faulty development in a part of the brain which usually occurs sometime before birth. Cerebral palsy ranges from mild to severe. In some cases there are associated problems such as learning difficulties and epilepsy. The main aim of treatment is to, as far as possible, prevent or limit the contractures and limb deformities that can occur, and to minimise any disability.

Cerebral is another word for the brain. Palsy means a complete or partial loss of the ability to move a body part.

Cerebral palsy is not a single condition. It is an umbrella term used to describe a group of conditions that cause movement problems. Although the main problem is with the muscles in one or more parts of the body, the condition is caused by damage or faulty development in a part of the brain. The part of the brain affected is in a part that sends messages to muscles to control movement and co-ordination. The damage or faulty development in the brain usually occurs as a baby is developing in the womb. Sometimes it occurs during birth, or shortly after birth.

SDR involves sectioning (cutting) of some of the sensory nerve fibres 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.

SDR begins with a 1-2 inch incision along the center of the lower back just above the waist. The spinous processes and a portion of the lamina are removed to expose the spinal cord and spinal nerves. Ultrasound and an x-ray locate the tip of the spinal cord, where there is a natural separation between sensory and motor nerves. A rubber pad is placed to separate the motor from the sensory nerves. The sensory nerve roots that will be tested and cut are placed on top of the pad and the motor nerves beneath the pad, away from the operative field.

After the sensory nerves are exposed, each sensory nerve root is divided into 3-5 rootlets. Each rootlet is tested with EMG, which records electrical patterns in muscles. Rootlets are ranked from 1 (mild) to 4 (severe) for spasticity. The severely abnormal rootlets are cut. This technique is repeated for rootlets between spinal nerves L2 and S2. Half of the L1 dorsal root fibers are cut without EMG testing.

When testing and cutting are complete, the dura mater is closed, and fentanyl is given to bathe the sensory nerves directly. The other layers of tissue, muscle, fascia, and subcutaneous tissue are sewn. The skin is closed with glue. There are no stitches to be removed from the back. Surgery takes approximately 4 hours. The patient goes to the recovery room for 1-2 hours before being transferred to the intensive care unit overnight.

          Advantages of SDR

·      Macey's spasticity will be permanently reduced

·         Macey's sitting and standing postures will be normal

·         Macey's balance and level of comfort will all improve 

·         Macey's walking will improve significantly and will be close to normal 

·         Macey will walk with  her flat feet

·         Macey will most likely not require any orthopaedic surgery now or in the future

·         Macey will not need physical therapy in the long term  

·         Macey will have minimal physical disability

·         If Macey has the surgery we expect that she will be able to participate in recreational sports and other fitness     activities.