The Center for Functional Restoration

The Hyman-Newman Institute for Neurology and Neurosurgery
Beth Israel Medical Center, Singer Division
New York, NY

?

Selective Dorsal
Rhizotomy

../../images/green-ball-small.gif - 102 Bytes Introduction

../../images/green-ball-small.gif - 102 Bytes Historical Development

../../images/green-ball-small.gif - 102 Bytes Candidate Selection

../../images/green-ball-small.gif - 102 Bytes Surgery

../../images/green-ball-small.gif - 102 Bytes Complications

Physical Therapy After Rhizotomy

? ../../images/green-ball-small.gif - 102 Bytes Introduction
? ../../images/green-ball-small.gif - 102 Bytes Assessment and Therapy
? ../../images/green-ball-small.gif - 102 Bytes Bracing
? ../../images/green-ball-small.gif - 102 Bytes The Role of
The Parent

../../images/green-ball-small.gif - 102 Bytes Results

? ../../images/green-ball-small.gif - 102 Bytes Movies Pre-and Post-SDR

../../images/green-ball-small.gif - 102 Bytes Conclusion

../../images/green-ball-small.gif - 102 Bytes ASCII text of Chapters

?

../../images/green-ball-small.gif - 102 Bytes Other Sites of Interest

?

Introduction

Selective posterior rhizotomy (also called functional dorsal rhizotomy) is a neurosurgical technique being used increasingly to treat spasticity (tightness in the muscles that resists rapid movement), especially in children with cerebral palsy. The procedure evolved from work done in the late nineteenth century. It is based on the assumption that spasticity results from loss of the modulating influences of nerves from the brain on the spinal cord's reflex circuits. There are a multitude of these reflex circuits, an example of which is the tendon jerk reflex (straightening of the leg in response to tapping the knee with a hammer). In this case sensors within the large muscle in the front of the thigh perceive the stretching of the muscle which results when its tendon is tapped by the hammer. A nerve impulse is sent to the spinal cord where it stimulates a nerve which sends a signal back to the thigh muscle causing it to contract and pull the leg straight. Nerves from the brain control these reflex circuits allowing us to voluntarily move a muscle without its reflexively tightening up. With injuries to the spinal cord or brain (e.g., cerebral palsy), these descending nerves from the brain can be damaged, resulting in an alteration of the controlling influences on the reflex circuits. The result is a spreading activation of nerves within the spinal cord and a subsequent contraction of numerous muscles throughout the body. This creates the typical picture of limb spasticity.

?

?

?