Procedure proves promising for young cerebral palsy patients

by Dr. T.S. Park

Dr. T.S. Park is neurosurgeon-in-chief at the highly rated St. Louis Children's Hospital and Washington University School of Medicine. He's performed selective dorsal rhizotomy, a specialized neurological procedure for patients with cerebral palsy, on more than 1,900 children and young adults from at least 48 states and 40 countries.

More than a half million Americans have cerebral palsy, a brain injury occurring at or shortly after birth that causes lifelong problems including difficulty walking, standing, sitting and maintaining balance.

For many, movement is limited by stiffened muscles. This involuntary tension, called spasticity, is caused by abnormally functioning nerve cells in the spinal cord and gets worse with age.

For more than two decades, I've done my best to tackle the problem in patients still young enough to benefit from surgical intervention. At St. Louis Children's Hospital, I perform a procedure called selective dorsal rhizotomy that involves cutting sensory nerves in the spinal cord.

Recently, I got a chance to follow up with Jen Wagner, an Angie's List member in Snellville, Ga., and the mother of 4-year-old Bailey, a patient of mine. Bailey couldn't run or play like other children or walk normally because of spasticity. She endured Botox injections every few months and multiple physical therapy treatments every week, all just to maintain what strength or flexibility she had.

But since her surgery in 2008, Bailey's movement has improved tremendously and so has her quality of life. Jen says Bailey dances - ballet and tap - does gymnastics, swims, runs and plays with her friends. Such stories from parents are gratifying to say the least.

Not that the procedure is a cure-all. Some patients still need assistive devices after surgery, such as crutches, though they may get along much easier. And not everyone with cerebral palsy is a candidate for the procedure which works best in cases that are mild.

Still, it's the only surgery that can permanently reduce or eliminate spasticity for people with cerebral palsy and give them back mobility. The surgery is less risky than it used to be as well.

Traditionally, the procedure required removing five to six levels of spine to access the spinal cord. But some of these patients developed long-term spine problems into their teen or adult years.

In 1991, I developed a less invasive technique in which I remove the bone from just one vertebra to access the spinal cord. It's a small incision and requires much precision to work in the 1-inch-wide area, but the approach enables patients to recover faster and have no long-term spinal problems. This technique opens the possibility of surgery to adults up to 40 years, though younger patients are still the norm.

At present, I'm teaching other surgeons to perform the surgery, in addition to doing about 150 procedures a year. There is still much work to be done for patients with cerebral palsy-related spasticity but I'm heartened by the encouraging notes and e-mails from parents. And I look forward to continuing the journey with patients, one limbered stride at a time.