Selective posterior rhizotomy is a surgical procedure that cuts posterior nerve roots in the lower spinal region to relieve muscle stiffness or spasticity in patients with cerebral palsy. It is a permanent surgery that can improve patient mobility, but may cause muscle weakness. It is usually performed on children between the ages of two and five.
Selective posterior rhizotomy is a surgical procedure performed to relieve muscle stiffness or spasticity that occurs in patients with cerebral palsy. During this procedure, posterior nerve roots in the lower spinal region that contribute to muscle spasticity are identified and cut. Preventing excess signals from these nerves can allow the patient to have greater control over muscle movement and improve quality of life.
Cerebral palsy is caused by an injury to the brain that can occur before, during, or shortly after birth. This injury is usually permanent and can interfere with the electrical signals that are sent back and forth between the brain and muscles. Two types of nerve fibers must work together to send and receive signals to and from muscles: sensory fibers send signals from the muscle to the spinal cord, while motor nerve fibers send signals from the brain to the muscle.
The motor nerve fibers in patients with cerebral palsy don’t work properly, which leads to an increase in signals from the sensory nerves to the spinal cord. This increase causes muscle stiffness, which in turn causes patients to have poor muscle coordination. Various forms of surgical and physical therapy are available to help patients regain muscle control. Selective posterior rhizotomy is a surgical treatment option that can reduce signals from sensory nerve fibers and improve patient mobility.
Selective posterior rhizotomy is usually performed on children between the ages of two and five. Patients must undergo a series of tests before surgery to determine the extent of muscle spasticity. Once a patient is a candidate, the child can be hospitalized. The surgery is performed while the patient is under general anesthesia.
To perform selective posterior rhizotomy, the surgeon makes an incision through the skin of the lower back. One or more vertebrae in the lumbar and/or sacral region of the spine are exposed. Removal of the lamina, the bony process on the vertebra, must be done to expose all nerve roots. The sensory nerve roots and the motor nerve roots are separated from each other and the motor roots are capped to ensure they are not disrupted.
The sensory roots are stimulated with electrical probes to determine which nerves are causing spasticity in the patient. These roots are then severed so that signals can no longer travel along those nerves. This is permanent surgery, so the surgeon must carefully decide which nerves to cut. Once the nerves are cut, the patient may experience muscle weakness even though the tension has disappeared. Muscle strength can be rebuilt through a rigorous physical therapy program, and the patient should have more control over muscle movement.
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