At Pain Management Manhattan, pain is first treated with the least disruptive techniques. Once a firm diagnosis is reached, rest and ice may be the first line of defense, followed by behavior modifications and corticosteroid injections. But your top-rated Manhattan pain specialists don鈥檛 stop until they find a treatment that provides you with long-lasting relief. If all other options haven鈥檛 delivered the pain relief you need, your doctor may suggest a selective dorsal rhizotomy (SDR) to get that relief. The best doctors in New York City can perform the right pain-relieving procedure for you.
Dorsal rhizotomy, often referred to as selective dorsal rhizotomy or SDR, is a surgical procedure designed to help if you or a loved one suffers from cerebral palsy or other conditions that involve muscle spasticity. It鈥檚 one of the most scrutinized procedures performed, and evidence shows that it鈥檚 an excellent option for certain people with spastic conditions that often result in extensive pain.
Two types of nerve roots lie within the spine and travel outward to your muscles. The ventral spinal root transmits motor information from your brain to your muscles. In contrast, the dorsal spinal root carries sensory signals back from the muscles to the spine and brain. During a Selective Dorsal Rhizotomy (SDR), our specialist identifies and sections specific sensory nerve fibers to reduce spasticity while preserving motor function.
Benefits of Dorsal Rhizotomy
Although often associated with the spasticity issues of individuals dealing with cerebral palsy, SDR also benefits anyone dealing with involuntary muscle contractions. Dorsal rhizotomy surgery, which is a minimally invasive surgical procedure, treats a number of conditions. The surgery helps:
- Those with cerebral palsy, especially children, dealing with lower extremity spasticity that hinders walking or proper hygiene
- Individuals who are relatively young, but experiencing the severe contractions associated with Parkinson鈥檚 disease
- Anyone suffering many of the debilitating aspects of multiple sclerosis
- Any spasticity concerns that haven鈥檛 responded to more conventional treatments such as medications or injections
- People dealing with chronic back pain and in need of a lumbar rhizotomy or cervical rhizotomy to target specific nerves, depending on the source of the pain
- Those with specific chronic spinal joint pain who can benefit from a facet rhizotomy
The goal of the surgery is to help you regain the ability to walk or to relieve pain by targeting and transecting the nerves that are hindering desired movement. It鈥檚 an effective procedure when performed by a trained pain specialist in New York City.
The SDR Procedure
No matter which rhizotomy surgery our doctors recommend, you require an inpatient hospital stay of at least a few days. Your doctor instructs you as to the exact process, but you can expect the following general steps:
- Before you check into the hospital, prepare for general anesthesia by not eating for several hours.
- You鈥檙e given the appropriate medication to make you sleep during the procedure.
- The surgical team moves onto your stomach so your surgeon can properly access your neck or lower back, depending on where your procedure is to take place.
- Your surgeon makes a small incision to find the correct nerve bundle or roots that are associated with your pain condition 鈥� such as the sensory nerve near your facet joint for lower back pain 鈥� and teases apart the separate nerves in any grouping.
- Your doctor identifies any nerves that seem to be malfunctioning by using a special microscope.
- Using an electrical probe, your doctor then identifies the exact nerve or nerves that are contributing to your spasticity or affecting the exact location of your pain.
- Then your doctor disables the nerve with an electric probe to prevent pain signals from reaching your brain.
- The incision is closed, cleaned and inspected.
- You鈥檙e taken to Recovery, where you鈥檙e monitored closely until you鈥檙e fully awake and conscious.
- Depending on where your incision is located, you may have to lie flat for a few days to allow the incision time to heal.
- Once you鈥檝e healed enough to move around, you start physical therapy, which you continue for several weeks, two to three times a week. You are retraining your other nerves to take over any lost function.
Selective Dorsal Rhizotomy Recovery
Without physical therapy, your other nerves won鈥檛 be able to take over the duties required for walking and other activities. You have to follow the physical therapy exercises to fully retrain your brain, muscles and nerves to recover desired mobility. Because you鈥檙e being treated by a team of top-notch doctors and staff, you know what to expect during each step of your recovery progress.
Because it鈥檚 a more invasive procedure than many other options, your doctor usually doesn鈥檛 recommend a selective dorsal rhizotomy as a first treatment option. But if you haven鈥檛 found results from more conservative treatments, you may find relief with SDR or other rhizotomy procedures. You can trust your exceptionally well-trained pain management specialist in NYC. Contact the practice today whenever you feel severe back or pelvic pain.
Medically Reviewed by Dr. Leon Reyfman, MD, FIPP, RPh
(Pain Management Doctor)