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Maximizing the Benefits of Spasticity Surgery

Maximizing the Benefits of Spasticity Surgery

Having deep experience in performing surgery to reduce spasticity and improve motor function in children with cerebral palsy (CP) reduces the risk of complications and increases the likelihood of a good outcome, says pediatric neurosurgeon Shenandoah Robinson.

Robinson should know—she’s been doing the procedure for 15 years now. But what makes as much of a difference in achieving the goal of the child being able to walk independently, she adds, is a multidisciplinary team approach and patient selection.

“Outcomes are greatly influenced by having the resources of a team of pediatric neurosurgeons and neurologists, anesthesiologists, intensivists, orthopaedic surgeons and physiatrists, which we’re fortunate to have,” says Robinson. “Screening for patients and families who are committed to intensive physical therapy for up to a year following the surgery is paramount.”

In the surgery, called selective dorsal rhizotomy, Robinson divides certain sensory nerve fibers entering the spinal cord from leg muscles, interrupting the abnormal circuit of nerve impulses in patients with CP that result in high muscle tone and spasticity. These patients, Robinson explains, lack inhibitory signals from the brain to dampen this feedback loop.

“We cut a fraction of the sensory nerve roots to help restore the feedback loop into a more normal range and give patients more selective control of their muscles,” she says.

Before cutting these nerve roots, however, Robinson, with the aid of a microscope, separates bowel, bladder and motor nerve roots to protect them. In another innovation, Robinson also uses a minimally invasive approach to minimize the removal of lamina covering spinal vertebrae.

After the four-hour surgery, patients may report their legs feel different and, in some cases, weaker—a consequence of losing their abnormal muscle tone in the surgery. But as spasticity is reduced, patients find it easier to increase their strength with therapy and exercise.

In that regard, Robinson notes that her patients benefit from Johns Hopkins’ close relationship with Mt. Washington Pediatric Hospital and the Kennedy Krieger Institute, both recognized for their pediatric physical therapy and brain injury rehabilitation programs.

“Our goal is to get these kids to be as normal as possible and to maintain that as they enter young adulthood and go off to college,” she says.

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