With specialized surgical training in selective dorsal rhizotomy, S. Hassan Akbari, M.D., and the team at Johns Hopkins All Children’s are growing the spasticity expertise and attracting more patients to the St. Petersburg hospital.
Hello, my name is Hassan Akbari. I'm one of the pediatric neurosurgeons at Johns Hopkins All Children's Hospital. The surgical spasticity clinic at All Children's Hospital provides a comprehensive multidisciplinary approach for spasticity care for our patients with cerebral palsy trauma or other conditions that cause spasticity. Our speciality Clin clinic has two physicians myself from the neurosurgery side, as well as Doctor Jim Tarian from the physical medicine and rehabilitation side to provide a comprehensive picture for our patients with cerebral palsy and spasticity. Doctor Tarian specializes in some of the medical treatments for spasticity. Why take care of some of the surgical aspects of this condition at our clinic? We do a formal evaluation including mobility, walking if the patient is able to do so, a strength assessment, as well as an assessment of the spasticity in the arms and the legs. To determine the best treatment option for our patients. From the surgical side of things, we have two primary surgical options. The first one is what's called a Baclofen pump in which we place a small catheter into the spinal cord with a pump that goes underneath the skin and the abdomen to directly deliver the medication, baclofen to the spinal cord and the spinal nerve roots. This allows for relaxation at those levels to help reduce the amount of spasticity. We are able to adjust the dosage of the medication delivered from the pump and also adjust the height of the catheter of the pump to get our maximum amount of benefit for our patients. Another option that I happen to like especially for our patients with spastic diplegia or spasticity affecting the legs is a selective dorsal rhizotomy in which we selectively cut about two thirds of the sensory nerve roots going down to the legs for each individual nerve root. I split those nerves into three parts and test those three parts to figure out which two are the most abnormal using intraoperative monitoring and then cut those two abnormal nerves. This allows for a rapid reduction in the spasticity of the lower extremities and requires then the patients to undergo either intensive inpatient or outpatient rehabilitation to regain strength and change their pattern of walking. Our results are quite dramatic for a lot of our patients. We can take them from having to say use a walker to be using crutches or using crutches to be able to walk independently without assistive devices for patients who are already doing that. But with an abnormal gait, they're able to walk in a much better way with a more normal gait pattern. Finally, we do have the option for what's called a palliative rhizotomy this rhizotomy does the same type of surgery but is meant for patients who have very severe spasticity in their legs where patients are getting contractors, fractures, dislocations or parents are having trouble caring for their child. We can do the surgery to rapidly reduce the amount of spasticity in the legs to overall improve comfort and patient care. The surgical spasticity clinic at Johns Hopkins, all children's hospital meets on a regular basis and we are more than happy to see any patient with spasticity. For a formal evaluation. You can find out more information on our website at the Spasticity Clinic for Johns Hopkins, all Children's Hospital and a special page about the selective dorsal rhizotomy procedure. Thank you.
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