Groundbreaking surgery – selective dorsal rhizotomy – helps little boy with PVL and cerebral palsy walk unaided for the first time

Henry Ford was born prematurely (35 weeks, ultrasound scan dates / 37 weeks, calculated dates) in 2004, and stopped breathing shortly after delivery.  He had to be resuscitated, followed by a stay in the neonatal intensive care unit (NICU).  At 4 months of age, Henry’s parents noticed that his eyes did not follow objects and he did not seem to focus.  Henry had an MRI (magnetic resonance imaging) scan, which is a test that uses magnetic waves to make pictures of structures inside the brain.  The results from the scan revealed that Henry has periventricular leukomalacia (PVL) with resultant nystagmus (involuntary eye movement) and spastic diplegia cerebral palsy.  This type of cerebral palsy is the most common, and it occurs in about 80% of all cases.

PVL

PVL is characterized by the death of the white matter near the cerebral ventricles due to softening of the brain tissue.  It can affect fetuses or newborns; premature babies are at the greatest risk of the disorder.  PVL is caused by a lack of oxygen or blood flow to the periventricular area of the brain, which results in the death or loss of brain tissue.  Since Henry stopped breathing at birth and he had to be resuscitated, his brain was likely deprived of oxygen.  If resuscitation maneuvers are not performed properly and quickly, brain damage can occur or worsen.

The periventricular area (the area around the spaces in the brain called ventricles) contains nerve fibers that carry messages within the brain.  Although babies with PVL generally have no outward signs or symptoms of the disorder, they are at risk for motor disorders (especially of the lower limbs), intellectual and development disabilities, coordination problems, and vision and hearing impairments.  PVL may be accompanied by a hemorrhage or bleeding in the periventricular-intraventricular area (the area around and inside the ventricles), and can lead to cerebral palsy.  The disorder can be diagnosed by ultrasound, but MRI of the head is diagnostically more accurate. Children with PVL should receive regular medical screenings to determine appropriate interventions.  The prognosis for children with PVL depends upon the severity of the brain damage.

SPASTIC DIPLEGIA CEREBRAL PALSY

Cerebral palsy is a term used to describe a group movement disorders that can range from mild to very severe.  Spastic diplegia is a type of brain damage that inhibits proper development of cells (motor neurons) in the brain that carry information to the muscles.  This affects various parts of the brain and spinal cord, and the result is that certain muscles become hypertonic or spastic, which means they remain very stiff.

The abnormally high muscle tone creates difficulty with voluntary and passive movement, and generally creates stress over time.  Depending on the severity of the condition, the continuous spasticity ultimately produces pain, muscle and joint breakdown, physical exhaustion, contractures, spasms, and misalignments of bone structure around areas of tightened musculature that get worse over time.

Spastic diplegia is acquired around the time of birth.  Exposure to toxins (such as too much bilirubin / untreated jaundice), traumatic brain injury, encephalitis, meningitis, PVL, hypoxia (lack of oxygen in tissue, including brain tissue), hematoma and hemorrhages in the brain, or the presence of certain maternal infections during pregnancy can all lead to spastic diplegia.  The main difference between spastic diplegia and a normal gait (body propulsion / movement) pattern is its signature “scissor gait.”

Scissor gait is characterized by the following:

  • Hips and pelvis are often locked, as if crouching while walking
  • Knees and thighs may cross or touch while walking
  • Ankles may be turned inwards while walking
  • Feet often make contact with the ground primarily at the ball of the foot, not the heel (may look like “tip toe” walking)
  • Arms and hands may go outwards from the body to provide balance

The degree of spasticity in spastic diplegia (and other types of spastic cerebral palsy) varies widely from child to child.  Balance problems and / or stiffness in gait can range from barely noticeable to misalignments so pronounced that the child needs crutches or cane to assist in being upright.  Spasticity can be so severe that the child is relegated to a wheelchair.

Above the hips, children with spastic diplegia typically retain normal or near-normal muscle tone and range of motion, though some spasticity may also affect the upper body.  Additionally, because leg tightness often leads to instability when in an upright position, extra muscle tension usually develops in the upper body, shoulders, and arms due to compensatory stabilization movements.

HENRY BEFORE AND AFTER GROUNDBREAKING SURGERY

Henry was unable to walk without the assistance of a special walker, called a Kaye frame.  At six years of age, Henry underwent a surgical procedure that has been shown to help children with spastic diplegia walk.  This surgery is called selective dorsal rhizotomy (SDR), and research has shown that when SDR is coupled with physiotherapy (PT), there is a  reduction in spasticity and an improvement in motor function.

SDR is a neurosurgical procedure that selectively destroys problematic nerve roots in the spinal cord.  During SDR, the lower vertebrae are opened to reveal the spinal cord, which contains neurons of the central nervous system.  These neurons (bundles of nerve fibers) relay messages between the brain and different areas of the body.  Electrical stimulation is used to identify and sub-divide sensory and motor nerves, cutting and eliminating the over-firing nerve rootlets and leaving the properly firing rootlets intact.  Due to the size of the nerves and rootlets, this is a very precise procedure and surgery can last many hours.

Many months of PT are needed after the surgery to train and retrain and strengthen the legs.  In fact, PT is necessary to obtain maximum benefit from SDR.

Five months after Henry’s surgery, he was able to ride a tricycle and walk up a big hill while holding someone’s hand.  He continues to get stronger and stronger.  One year post-surgery, Henry’s improvement continues with leaps and bounds.  He often uses walking sticks, called 1 point canes, and his confidence increases.  In addition, he began taking steps on his own, without any assistance.  These short walks are amazing because Henry’s family had been told that he would never walk unaided.

Indeed, it is wonderful to watch the videos of Henry to see how much his motor function and ability to walk have improved.

Watch Henry’s SDR fundraising video.

Watch Henry, 6 months post-surgery.

HELP FOR FAMILIES WHOSE CHILDREN HAVE CEREBRAL PALSY

If your baby suffered any birth complications and has been diagnosed with cerebral palsy, please contact the nationally recognized birth injury attorneys at Reiter & Walsh ABC Law Centers.  For decades, we have been helping families in Michigan and throughout the nation whose children have cerebral palsy. We have numerous multi-million dollar verdicts that attest to our success, and we will fight to obtain the compensation you and your family deserve for lifelong care and treatment.  We will evaluate your case to determine if your newborn suffered injuries due to the negligence of the physician or medical staff, and you never pay any money until we win your case.  Call us at 888-419-2229.

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6 replies
  1. Reiter & Walsh Staff says:

    Thank you for your comment, Shariff. You will be contacted by a member from the Reiter & Walsh, PC team. Please reach out with any additional questions or concerns.

  2. Reiter & Walsh Staff says:

    Thank you for your comment, Shariff. You will be contacted by a member from the Reiter & Walsh, PC team. Please reach out with any additional questions or concerns.

  3. Reiter & Walsh, P.C. says:

    Dear Visitor,

    Thank you for leaving a comment at http://www.abclawcenters.com regarding your child’s cerebral palsy. We regret to hear about your child’s diagnosis. We are a law firm handling birth trauma cases in the United States. Regretfully, we will be unable to assist you with a case, as we have no contacts in Pakistan at this time. Also, as we are attorneys and not doctors, we are unable to provide medical advice. We will be closing your file with our office.

    We advise you to please contact a physician and attorney licensed to practice in Pakistan immediately. Again, we regret that we cannot assist you. We wish you and your family the best of luck.

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