Rhizotomy Surgery Helps 5-Year-Old with CP, Spasticity to Walk

Five-year-old Bhoomi Manjunatha, born with cerebral palsy and spasticity, underwent a surgery called rhizotomy at Nationwide Children’s Hospital, which was successful in making her less dependent on her walker and wheelchair, and more on her own two feet.

The work and determination that Manjunatha has been showing in physical and occupational therapy also is helping her to recover, according to her physicians and therapists.

Selective dorsal rhizotomy is a procedure used to improve spasticity (muscle stiffness) in cerebral palsy. Spasticity affects 80% of people with cerebral palsy.

The selective dorsal rhizotomy Manjunatha had four months ago was performed by Jeffrey R. Leonard, MD, chief of neurosurgery at Nationwide Children’s. The surgical procedure is performed on the lower spinal cord; nerves are separated and then identified via an electrical stimulation. Following identification, certain sensory nerve fibers in the spinal cord are cut. The nerves that lead to too much muscle tone, resulting in spasticity, are cut.

Leonard and colleagues are still working with Manjunatha, and gather data about her clinical improvements. She is walking and feeling less pain, and the doctors believe her posture will get better, and one day she will need less orthopedic procedures.

“The surgery went well, but my part is easy. It is Bhoomi who has months of hard work and therapy ahead of her to strengthen her muscles to take advantage of her newfound mobility,” Leonard, who is also a faculty member at The Ohio State University College of Medicine, said in a press release. “Without a multidisciplinary team of inpatient rehabilitation, outpatient physical therapy and occupational therapy working together, the benefits of rhizotomy would not materialize,” he said.

“Bhoomi is bright and energetic, you can see that from her smile. She is motivated and did everything that the therapist asked of her, working really hard in rehabilitation,” said Leonard. “I think she is going to be dramatically effected in a very positive manner after having undergone the rhizotomy.”

According to Leonard, other treatment options for spasticity are available: Rhizotomy, orthopedic procedure, therapy alone and pump placement. However, very few studies have compared these procedures. So, in his consultations with families, Leonard advises them on the best treatment options for each patient.

Clinicians at Nationwide Children’s approach each case individually, meaning that every child diagnosed with a neurological condition is offered a custom treatment plan. Children with spasticity must be tested to determine if they are eligible for rhizotomy.