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Minimally Invasive Neurosurgery Eases Mobility Symptoms of Spastic Cerebral Palsy in Select Patients

August 29, 2023

Spasticity in pediatric cerebral palsy patients can be treated using a minimally invasive approach to selective dorsal rhizotomy (SDR) surgery offered by pediatric neurosurgeons at Orlando Health Arnold Palmer Hospital for Children. This surgical technique specifically targets the disinhibited muscle stretch reflex arcs contributing to spasticity. During the procedure, the most problematic dorsal (sensory) nerve rootlets contributing to spasticity are identified through intraoperative real-time neurophysiologic testing and selectively sectioned.

Following SDR surgery, an intensive SDR-tailored physical therapy protocol plays a crucial role in achieving a permanent and significant improvement in a patient's gait and ambulation in appropriately selected patients. For those with more severe spastic quadriplegia, SDR offers improved comfort and facilitates easier patient care.

While SDR is well-established for improving spasticity, surgical techniques can vary. "We prefer the minimally invasive, single-level laminectomy or laminoplasty approach at the conus medullaris, which only certain centers offer," says Ryan Jafrani, MD, a dual fellowship-trained pediatric neurosurgeon at Orlando Health Arnold Palmer. Dr. Jafrani completed his advanced fellowship training at Washington University in St. Louis under the direction of Dr. T.S. Park, who pioneered this minimally invasive approach to SDR, performing the entire procedure through a single-level lumbar surgery.

"With a much smaller incision compared to traditional techniques and single-level opening, our minimally invasive, collaborative approach to SDR results in less operating time, minimal disruption of anatomy and shorter recovery times, leading to excellent outcomes for our patients," says Dr. Jafrani. While SDR is widely recognized for its effectiveness in managing spasticity, the availability of minimally invasive surgical techniques, tailored SDR protocols and comprehensive multidisciplinary care is limited.

The Pediatric Spasticity Program at Orlando Health Arnold Palmer, integrated into the Leon Pediatric Neuroscience Center of Excellence, features a unique Multidisciplinary Spasticity Clinic. This clinic brings together PM&R doctors, neurosurgeons, orthopedic surgeons, physical therapists, occupational therapists and social workers in one location, fostering a collaborative effort for enhanced care coordination dedicated to children with cerebral palsy or spasticity.

For more information on treatment options for spasticity, please call (321) 841-3050.

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