Selective dorsal rhizotomies (SDR) were first performed at BC Children’s Hospital by Dr. Steinbok in February 1987, and we were the first center in Canada to do this procedure. Dr. Steinbok has performed over 250 rhizotomies. Most of the children have been from British Columbia, but patients have come from other provinces in Canada and from outside North America for this operation. From the onset, we have developed a team approach to the assessment and treatment of children, who are referred for consideration of selective dorsal rhizotomy. We have been very fortunate to have an orthopedic surgeon and neurosurgeon working together and not competing with each other. The program has made a point of assessing outcomes after rhizotomy, and indeed was the first group in the world to assess outcomes quantitatively after this procedure. There have been over 20 peer reviewed publications from our program on the subject of dorsal rhizotomies, and Dr. Steinbok, who does the surgery, is acknowledged to be one of the world’s experts in this operation.
Initially SDR was done via multilevel laminectomies from L1 to S1, but more recently the procedure has using a less invasive single level laminectomy approach at L1, similar to that performed by Dr. Tae Sung Park in St. Louis. Over 20 operations have been completed using the less invasive technique and this has resulted in shorter hospital stays, less postoperative pain and a smaller incisional scar for the children, with no difference in efficacy. It is also hoped that in the longer term there will be less spinal deformity, such as scoliosis, associated with the less invasive SDR.
Our results with selective dorsal rhizotomy have been very gratifying. Over 90% of the children have had significant improvement as a result of the operation. More than 50% have improved in their level of ambulation, for example from walking with a walker to walking with crutches or independently. The reason the number is lower than the 90% who improve overall is as follows. Some children can walk independently even before their rhizotomy, so the most that can be expected is for the rhizotomy to improve their gait. Other children, who may be wheelchair bound, are operated on to make it easier for their care givers to look after, with no expectation that they will be able to get out of the wheelchair. Furthermore, other children may improve, and for example walk better with a walker, but never get to the next level of walking with crutches. The complications after selective dorsal rhizotomy have been reviewed in detail and have been published. Our complications have been few and have been as good as or better than any other series reported.
Our experience has been that the best candidates for selective dorsal rhizotomies are children with spastic diplegic cerebral palsy, with spasticity affecting many muscle groups in the lower limbs, between ages 3 and 8 years. All prospective patients are assessed by Dr. Steinbok, Dr. Beauchamp, orthopedic surgeon, a physiotherapist and an occupational therapist. The surgery is done with assistance of neurophysiology technologists and takes about 3-4 hours. The child is usually discharged after 4 days and usually returns to school after 1-2 weeks. There are no casts required, and the child can resume all activities after the incision has healed, which is usually by 2-3 weeks. Children receive physiotherapy in their home communities thereafter and return for reassessment at 3 and 12 months, if possible. We know that in other centers the surgery is longer and the hospital stay is longer, but our results and complication rate are among the best in the world.