Hi, Regina !
The USC Neurosurgery site offers a definition of "Rhizotomy" and a
brief explanation by Dr. John Peter Gruen at:
http://uscneurosurgery.com/glossary/r/rhizotomy.htm
"sympathetic nerve roots (rhizo = root in Greek or Latin, otomy =
cutting of) "
Rhizotomy has historically been used in the treatment of spasticity,
and involves surgically cutting those nerves involved in the
involuntary muscle movements or the overtight muscles. The surgery has
been performed since 1913, and as you would expect it has been very
considerably refined since then.
The Connecticut Children's Medical Centre has a simple explanation at:
http://www.ccmckids.org/departments/Orthopaedics/orthoed4.htm
"Many patients with Cerebral Palsy (C.P.) have tightness/spasticity in
the muscles of their arms, legs, and trunk. Spasticity can decrease
the speed of movement, limit flexibility, and interfere with the
development of walking. Over time, contractures (fixed tightness) of
the joints and deformities of the bones can develop from continuing
spasticity. Selective Dorsal Rhizotomy can reduce this spasticity. "
They say that it is a small percentage of patients that can benefit,
and gives a guideline as to the suitable types of patient. These
include those with Spastic Diplegia or Quadriplegia.
A very clear explanation of the whole procedure in much more detail
with a balanced discussion of what improvements can be expected can be
found on the website of the St. Louis Children's Hospital Center for
Cerebral Palsy Spasticity at:
http://cerebralpalsy.wustl.edu/rhizotomy.html
Be warned, there are photographs of actual surgery on this page.
They say:
"Of all the surgical procedures currently performed on patients with
cerebral palsy , selective dorsal rhizotomy has undergone more
thorough scientific scrutiny than any other (including orthopaedic).
Accumulated evidence and our own experience indicate that SDR is an
excellent option for selected patients with spastic CP. We think
parents and patients need to inquire about SDR as a part of the
management of CP."
There is a PDF file (from which I cannot cut and paste) specifically
written for parents outlining the whole surgical and follow-up
procedures at:
www.clarian.org/pdf/pediatrics_dorsal_rhizotomy.pdf
This is the Clarian Health, Methodist IU Riley website.
A personal story is told in Kim's Rhizotomy Journal to be found at:
http://sessions4.tripod.com/SDR
which covers Kim's prgress for a year after the surgery, and you can
find mention of a 1994 follow-up study of 100 patients by Gillette
Children's hospital on their site at:
http://www.gillettechildrens.org/programs-services/spasticity/casestudydorsal.html
"Parent survey indicates positive outcomes
In 1994, Gillette conducted a survey of 100 families with a child who
was at least 6 months post rhizotomy.
* Major findings included:
A 15 % increase in the number of children who could walk.
75% of the children had an increase in lower extremity motor control.
More than 40% of the children had an increase in arm control and
strength.
Improved self-care abilities and endurance.
95% of parents reported a slight or marked improvement in their
child's mobility.
41% of the patients went on to have orthopaedic surgery following
rhizotomy.
* Since the introduction of intrathecal baclofen for children, the
selection criteria for rhizotomy surgery has changed slightly and
outcomes may differ today. Children who are non-ambulatory are now
more likely to be candidates for an ITB pump implant. "
There is also a case study of a child with spastic diplegia.
For your interest Rhizotomy is also used in the field of chronic pain
management and a diffierent technique is described at the website of
the Center for Diagnostic Imaging:
http://www.cdirad.com/cdi/tectrix/program/content/141/169.php
"Radiofrequency (RF) rhizotomy, or RF neurotomy, is a therapeutic
procedure designed to decrease or eliminate pain symptoms within
spinal facets.
The procedure involves using a needle to carefully place a small
electrode adjacent to the facet under x-ray guidance. An electric
current is then used to cauterize the sensory nerves that innervate
the facet joint(s). If successful, the pain relief following an RF
procedure can last considerably longer than relief following local
anesthetic and steroid blocks."
I hope this question does not arise because of a problem within your
own family or friends. If so, obviously you doctor is in the best
position to advise, but what I have been able to find suggests the
procedure is well regarded.
Search strategies:
rhizotomy
dipareses
diapareses
and the Chambers dictionary |
