[6] Spasticity is thought to be caused by an excessive increase of excitatory signals from sensory nerves without proper inhibition by GABA.
[citation needed] In 1913 Otfrid Foerster in Germany reported the results of dorsal root rhizotomy on patients with spastic cerebral palsy.
In 1967 Claude Gros and his colleagues at the neurosurgical hospital (CHU Gui de Chauliac) in Montpellier resurrected posterior rhizotomy for spasticity.
Fasano of Italy in 1978 introduced 'selective' posterior rootlet rhizotomy for cerebral palsy patients and Warwick Peacock[8] developed the Gros technique in Cape Town, South Africa, by exposing the cauda equina, rather than at the spinal cord level.
Peacock moved to Los Angeles in 1986 and began widely campaigning for SDR's viability in cerebral palsy spasticity relief.
Anderson performed an SDR surgery on a 28-year-old male with moderate spastic diplegia, which by the patient's own report has reduced his muscle tone nearly to the level of a "normal" person and enabled him to walk and exercise much more efficiently; also, Anderson in the past performed an SDR on a 16-year-old wheelchair-using female with severe spastic diplegia.
And in July 2011, after offering her several months of consultation, the medical team at the Continuing Care department of Gillette Children's Specialty Healthcare performed an SDR procedure on a local young-adult Minnesota resident.Meanwhile, many countries such as the United Kingdom, Russia, and China adopted the dorsal rhizotomy to treat spastic cerebral palsy.
[10][11] Selective dorsal rhizotomy surgery has been performed routinely over the past several decades on children with spastic cerebral palsy, and the accumulated evidence indicates positive long-term outcomes.
There must also be evidence of adequate motor control or the ability to make reciprocal movements for crawling or walking and to move reasonably quickly from one posture to another.
In adults, the primary requirements are that the person is able to ambulate independently, but spasticity limits energy, flexibility, walking speed, and balance and sometimes causes pain/muscle spasms.
The neurosurgical team at Seattle Children's Hospital has modified the surgical approach described above by tailoring the selection of nerve root sectioning to the individual patient.
At Seattle Children's, the laminectomy is performed below the termination of the spinal cord (conus), potentially reducing the risk of injury.
The surgery takes approximately 4 hours and typically involves one neurosurgeon, one anesthesiologist, and possibly an assortment of assisting physicians (as in the New York City September 2008 case).
After that short period, the patient, depending on circumstances and appropriateness, is either transferred to inpatient recovery or is linked to an intense outpatient exercise program and discharged from the hospital.
Fixed orthopaedic deformities of the legs caused by the previous years of intense spasticity are also not relieved by the SDR and must also be corrected surgically.
If a certain degree of permanent numbness remains in certain leg muscles, such as the quadriceps, ankles, and feet, this is usually not enough to prevent feeling and sensation, sensing of changes in temperature or pressure, etc.
The affected muscle areas simply feel less than before, and the trade-off in ease of movement is said to be immensely worth this change, should it occur.
Outcomes following a SDR can vary based on the number of nerves cut during surgery, joint deformities, muscle contractures, and level of impairment before the procedure.
Physical therapy post SDR aims to promote independent walking, improved gait pattern, transfers, balance, and upper limb motor control.
A strengthening program is beneficial to combat this expected weakness and improve lower extremity range of motion and facilitate a near normal gait pattern.
Weeks 3 through 6 focus on the previously mentioned items but adding gait training, assessment for the need of assistive devices, and preparing a home program for the patient.