Selective Dorsal Rhizotomy

Selective Dorsal Rhizotomy Treatment

Spasticity is a common cerebral palsy symptom characterized by muscle stiffness and involuntary contractions throughout the body. A selective dorsal rhizotomy (SDR) procedure can be effective in reducing a child’s spasticity, especially in their lower limbs.

An SDR is a neurosurgical procedure where surgeons identify the nerve rootlets sending abnormal messages in the spinal cord. They sever these rootlets to reduce overactive signals, improving the child’s motor control and helping them regain critical function.

A selective dorsal rhizotomy can lessen the long-term effects of high muscle tone on bones and joints. This can allow a child with cerebral palsy to experience greater comfort and range of movement.

But these kinds of procedures come with a long recovery process and other hurdles. Additionally, the cost of these procedures alongside other cerebral palsy treatments can place a high financial burden on struggling families.

Proper medical care during birth can sometimes prevent life-altering brain injuries that cause cerebral palsy symptoms. While some brain injuries are unavoidable, negligent action during labor and delivery can increase the risk of neonatal brain damage.

Families may be eligible for compensation when they can trace their child’s cerebral palsy diagnosis back to mistakes during birth. When a healthcare professional’s negligence leads to permanent and preventable injuries, it may constitute medical malpractice.

Our firm helps families prove medical malpractice to recover the compensation needed to afford life-changing treatment like SDR procedures.

Cerebral Palsy Malpractice Attorneys

Our top rated cerebral palsy attorneys specialize in birth injury medical malpractice. We understand how medical mistakes during delivery can cause brain injuries that permanently impact a child’s life.

If your baby’s preventable birth injuries led to a cerebral palsy diagnosis, don’t hesitate to contact our firm. We can answer difficult legal and medical questions and investigate the facts on your behalf.

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Cerebral Palsy Lawyers
(888) 987-0005

Our Cerebral Palsy Lawyers are available to meet you in your home or the hospital.

Our vast network of medical experts and in-house nursing staff and nurse-attorneys gives us the edge over our competition. When we take your case, we assign you with not just an attorney but an entire medical team. This team includes attorneys, experienced nursing advocates, and seasoned medical experts.

We understand the extensive care your child requires to assist with their cerebral palsy symptoms. Your team is available to assist with any day-to-day treatment you or your child may need. This includes assistance with obtaining medical records, scheduling doctors’ appointments, providing transportation, and any other problems that may arise.

We offer all of this on a contingency fee basis. This means you will not pay any fees until after we win your case and secure a settlement. We have an unmatched track record of birth injury results that sets us apart from other birth injury law firms.

Recent Birth Injury Settlement:
Cerebral Palsy Birth Injury settlement against a hospital in which nurses and physicians failed to detect a uterine rupture during delivery causing an HIE event which caused cerebral palsy. Our dedicated cerebral palsy birth injury lawyers recovered $9,200,000 for the family to help with future medical expenses and developmental therapy.

Million Dollar Results

What is Selective Dorsal Rhizotomy (SDR)?

Selective Dorsal Rhizotomy (SDR) is a surgical procedure that corrects abnormal communication between the brain, spinal cord, muscles, and nerves. It is currently the most effective treatment option for permanently reducing spasticity in children and adults with spastic cerebral palsy.

Sensory nerves collect information from a muscle and carry it to the spinal cord. The spinal cord then sends motor nerves back to the muscles, causing them to contract.

Typically, the brain communicates with the spinal cord to control muscle activity. However, in children with cerebral palsy, the brain does have the same control. As a result, the spinal cord instructs some muscles to produce continuous contractions.

Selective Dorsal Rhizotomy is a very precise procedure that typically lasts several hours and requires general anesthesia. During the procedure, the surgeon will create a small (two to four-inch) incision in the child’s lower back. This gains them access to the spinal cord and exposes the nerve fibers.

The surgeon then tests specific nerve roots using electrical stimulation to identify and sub-divide sensory nerves from motor nerves. This allows surgeons to target only malfunctioning nerves without affecting the ones responsible for essential functions like leg movement.

Once identified, the surgeon carefully cuts the malfunctioning nerve roots to decrease the abnormal signals. The surgeon then closes the membranes covering the spinal cord. They will apply pain relief medication to the nerves and return surrounding muscles to their original positions. After completing all of these final steps, the surgeon can close the incision.

Factors to Consider Before Selective Dorsal Rhizotomy

Not all children with cerebral palsy would benefit from a selective dorsal rhizotomy. A child’s likelihood for benefitting from the surgery depend on their specific cerebral palsy symptoms and other factors.

A team of experts should first evaluate whether the procedure is suitable for each child. This team may include nurses, neurosurgeons, pediatric orthopedic surgeons, physical and occupational therapists, and pediatric rehabilitation medicine physicians.

Some of the factors this team may consider include:

Cerebral Palsy Type

Not all cases of cerebral palsy are alike. A child’s classification of cerebral palsy will depend on the location and severity of their brain damage at birth. Children with spastic diplegia are the best candidates for SDR surgery. Research also supports using SDR surgery for the treatment of spastic hemiplegia.

Children with dyskinetic cerebral palsy and ataxic cerebral palsy may only experience small levels of spasticity. The symptoms of these cerebral palsy subtypes do not usually indicate the need for a procedure like SDR.

Types of Cerebral Palsy

GMFCS Level

Gross Motor Function Classification System

Medical professionals can categorize children’s gross motor skills into five distinct levels using the Gross Motor Function Classification System (GMFCS).

Gross motor skills refer to physical tasks and abilities that require muscle coordination like sitting up, standing, walking, and jumping. A level 1 on the GMFCS indicates the child only suffers from very mild limitations to their movement. A level 5, on the other hand, indicates a child having severe limitations with little to no muscle control.

Children at levels 4-5 may not benefit from an SDR procedure as they will likely never walk on their own. They will likely use wheelchairs and other mobility devices throughout their lives to move around.

Alternatively, children at levels 1 through 3 who can walk on their own may be good candidates. An SDR procedure may empower them with the restored motor function needed to improve their walking and lessen their pain.

About GMFCS

Gait Analysis Data

Experts must identify whether your child's movement pattern stems from spasticity or another movement disorder.

A gait analysis plays an essential role in allowing surgeons more accurately diagnose motor disorders and provide treatment solutions. This important decision-making tool measures oxygen consumption and how much energy the child uses when walking. Experts can use this data to accurately identify and quantify gait deviations.

Good candidates for SDR surgery typically require approximately 200 to 600 percent more energy to walk than others use.

The Child's Age

The best candidates for SDR surgery are children ages 4 to 7 who suffer from spastic cerebral palsy. Although the target population for selective dorsal rhizotomy is children between 2 and 6, older children can also benefit.

Selective Dorsal Rhizotomy requires those under 18 years of age to:

Be at least 2 years old
Have either a spastic diplegia, quadriplegia, or hemiplegia diagnosis
Be able to crawl or walk with or without an assistive device
Be born prematurely or have typical signs of spastic diplegia
Possess the potential for improvement in functional abilities

Overall, children who have good muscle strength but experience chronic spasticity are good candidates for selective dorsal rhizotomy surgery. Older children and adults must be able to walk independently but feel inflexible or imbalanced during movement.

There are a few situations where a child may not be a suitable candidate for SDR surgery. These include:

A child who has suffered meningitis
A child with a congenital brain defect
A child with congenital hydrocephalus that is unrelated to premature birth
A child with some sort of familial disease (i.e., a child with hereditary spastic diplegia)

Even if your child does not qualify for SDR, a physician can provide useful information on relevant cerebral palsy treatments.

However, if your child is a good candidate, they must first undergo a spasticity evaluation. This will first include a physical examination, and then doctors may also conduct additional tests and scans.

A medical professional may request a Magnetic Resonance Imaging (MRI) scan to determine the location of the child's brain injury. They may also request an X-ray scan to assess their hip stability.

Although children with upper-extremity and lower-extremity spasticity may benefit, SDR primarily alleviates spasticity and pain within the lower body. Pre-operative evaluation is crucial to determining whether an SDR procedure is worth it for your child.

What Are the Benefits and Risks of Rhizotomy?

After any kind of rhizotomy procedure, a child with cerebral palsy will feel a reduction in spasticity almost immediately. A selective dorsal rhizotomy will specifically benefit children who experience spasticity in their legs.

Other potential benefits of SDR include:

Eliminating or reducing spasticity
Improving how muscles move and function
Increasing ease of movement and comfort
Preventing long-term structural deformities
Enhancing balance and improving flexibility
Improving walking patterns and speed
Improvements in speech and cognitive abilities

Selective dorsal rhizotomy can help children with spastic quadriplegia operate assistive equipment and devices more independently. For example, the procedure may give them the flexibility to use a potty seat and power a wheelchair on their own.

Caregivers may also find changing their diapers or using adaptive feeding devices easier. Most children return to their baseline level of mobility one to two weeks after surgery.

Early SDR can reduce your child's need for orthopedic procedures like osteotomy surgery in the future.

Potential Negative Effects of SDR Procedures

Wound infections
Meningitis Infection
Cerebrospinal fluid (CSF) leaks from the wound
Sensitivity of the skin on the feet and legs (usually goes away in 2 to 3 weeks)
Temporary changes in bladder and bowel control
Curvature of the spine
Back pain
Spinal stenosis
Dehydrated spinal disks (black disks)
Disk protrusion

In addition, children may experience mild headaches or have uncomfortable leg spasms after the procedure. Some children may need additional treatments like orthopedic surgery to maximize mobility.

But despite these risks, there is overwhelming evidence of SDR bringing positive improvement in children with lower leg spasticity.

What Does Recovery Look Like After SDR?

Post-operative rehabilitation is essential to truly benefit from SDR. Before surgery, your doctor should ensure your child will cooperate with the therapeutic regimen and devise a clear physiotherapy plan.

In the first few days after surgery, doctors recommend that the child stays on bedrest. A medical professional may closely monitor your child to ensure they are recovering normally. They will provide appropriate pain management with medication given through IV.

Before leaving the hospital, the child's doctor will advise parents on what level of activity is appropriate without risking overexertion. The doctor will also review medications and incision care with the parents or caregivers. They will also advise how frequently the child should return for follow-up appointments.

Physical Therapy

Your child will begin Physical Therapy within a few days after the surgery. During physical therapy, their body will develop new nerve pathways that support better movement.

Despite initial weakness in the months following SDR, most children quickly move better and adapt to their new muscle tone. Therapists will work with your child about 3-4 times weekly to improve their range of motion, posture, and muscle strength.

Physical therapy will involve exercises, games, and assistive technologies. The therapist designs exercises to stretch the child's muscles, ease movement, improve posture, increase strength, and develop balance. They will also teach parents and caregivers how to do the exercises at home.

Physical Therapy for CP

The first weeks after SDR surgery are critical for establishing new patterns of walking and moving. Children old enough to understand and follow post-operative instructions will likely have the smoothest recovery. Having the availability for in-person therapy help can also give children an advantage in their recovery.

Your child's care team will provide long-term follow-up care and work to address any concerns and additional needs. Intensive physical therapy typically lasts for at least six weeks. Most children will gradually regain muscle strength and improve gait within six months.

What Causes Cerebral Palsy?

Cerebral Palsy (CP) is a neurological disorder caused by brain injuries occurring before, during or shortly after birth. In some cases, parents may notice signs of cerebral palsy soon after birth. In other cases, signs of the disorder may not appear until a few years later.

The most common type is spastic cerebral palsy, which makes it difficult for children to control their arms and legs.

Most Common Causes of Spastic Cerebral Palsy

Cerebral Palsy Causes

Doctors classify spastic cerebral palsy into three sub-types: quadriplegic, diplegic, or hemiplegic. SDR is most beneficial for children who suffer from spastic diplegia or spastic hemiplegia. The most common candidates for SDR are children with spastic diplegic cerebral palsy that affects the legs.

Children with severe spastic quadriplegia may experience an increase in physical comfort and independence after SDR surgery. However, SDR has a lower success rate for children with spastic quadriplegia and a higher risk of spasticity recurrence.

Medical mistakes at birth can sometimes contribute to a child’s brain injuries that cause cerebral palsy. While some brain injuries are unavoidable, negligent action during labor and delivery increases the risk of neonatal brain damage.

It’s worth speaking to a cerebral palsy attorney to determine if medical malpractice played a role in your child’s conditions.

Did Medical Errors Worsen My Child’s Cerebral Palsy Symptoms?

Cerebral palsy will affect every physical aspect of a child’s life. Children with extreme spasticity can benefit from a selective dorsal rhizotomy to restore their mobility and improve motor skills.

Treatments and therapies for cerebral palsy symptoms can be incredibly expensive and put families into difficult financial situations. No family should have to make the incredibly painful choice between paying for everyday bills and expenses or life-altering treatment.

Families may be entitled to financial compensation when their child’s cerebral palsy diagnosis stemmed from medical mistakes.

Errors during birth, such as delaying an emergency C-section or prolonging oxygen deprivation at birth, can cause irreversible brain injuries. This brain damage at birth can result in movement disorders that culminate in a cerebral palsy diagnosis during early childhood.

If a family believes medical negligence worsened a child’s brain damage at birth, legal support may be an option. A cerebral palsy attorney can review the medical records and circumstances to assess whether a claim exists.

Families who have experienced the effects of brain injuries from negligent medical care deserve to know whether they were avoidable. Our cerebral palsy attorneys specialize in birth injury medical malpractice, helping families seek compensation when negligence causes lifelong conditions.

Our team will thoroughly investigate the facts, holding responsible parties accountable by pursuing medical malpractice claims.

What is the Statute of Limitations in a Birth Injury Case?

A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the case and the state where you file.

For instance, the deadline for birth injury claims is typically different from other claims, such as injury to private property.

Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule. In some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.

For example, if the party that injured you was:

A federal employee
Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity

You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, you may have less time to give notice if:

The negligent party was a local or state government hospital
The doctors and medical providers are employees of a governmental entity

If you file your case outside of the statute of limitations, the court will typically dismiss it. This means you will not be eligible to recover compensation for you or your child’s injuries.

Determining when a statute of limitations begins on your case can be tricky. Our cerebral palsy attorneys specialize in birth injury medical malpractice and can tell you important cutoff dates in your state.

How Can Our Cerebral Palsy Attorneys Help?

A selective dorsal rhizotomy procedure and the intensive physical therapy that follow it can be costly. A child with cerebral palsy requires ongoing treatments and therapies estimated to exceed approximately $1 million over their lifetime.

If you believe their conditions are the result of medical negligence or malpractice, you may be able to recover compensation. This compensation can cover the cost of medical procedures, therapies, assistive equipment and devices, and other cerebral palsy-related expenses.

A detailed expert review of the facts and circumstances of your pregnancy and your child's birth can reveal many things. Namely, it can determine whether a child’s cerebral palsy diagnosis and related symptoms were the result of medical malpractice.

Our Process

Our team of cerebral palsy attorneys specializes in birth injury medical malpractice and can help assess your potential cerebral palsy case. We use our detailed medical negligence case review process to take in your information and begin learning more.

We start by gathering information about your pregnancy by examining records to determine what happened during and after your delivery. This includes evaluating the fetal heart rate strips during labor and any action medical professionals took in the NICU.

We will call in skilled medical experts who review your records and provide insight into where medical professionals went wrong. If we feel medical negligence caused or worsened your baby’s cerebral palsy symptoms, we meet with you to discuss further.

At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment once you do. The sooner you reach out, the sooner we can investigate your case and gather the evidence to support your claim.

We work on a contingency fee basis, meaning you will not pay any legal fees until we win your case. We do not purse any medical malpractice cases unless we fully believe we can win.

Contact us today to schedule your free consultation by calling our toll-free line at (888) 987-0005. You can also reach us by filling out our online request form.