No big deal, right?
Okay, so it's a pretty big deal.
The surgery is called selective dorsal rhizotomy (or SDR). Selective, because it involves the surgeon carefully selecting which nerves to focus on, using an EMG to measure the electrical activity in them and identify which ones are problematic. Dorsal, because it involves the nerves in the dorsal root (that is, the sensory portion) of the spinal nerves involved rather than the ventral root (that is, the motor portion). Rhizotomy, because that's that fancy medical term for a surgery that involves severing some of the nerve roots.
This surgery is a common procedure for kids with spastic diplegia due to cerebral palsy. That's the case for Zoe. She was born prematurely, probably around 30 weeks, which resulted in periventricular leukomalacia (PVL). Those big words mean that portions of her brain that control motor development never formed. As a result, her brain sends some wrong messages to her body. For her and other people with spastic diplegia, those error messages tell her muscles to tighten up. We do a lot of daily stretching, but that's not enough. The spastic tightness in her hips, legs, and feet are why she can't sit, crawl, or walk independently like other kids who are about to turn 3 like she is.
In SDR, the surgeon will open up Zoe's back, remove part of one of her vertebrae, separate her motor nerves from her sensory nerves, prod her sensory nerves with an EMG to determine which ones are sending the wrong messages to her body, and then permanently cut those unhelpful nerves.
But we wouldn't be doing this if the benefit didn't outweigh the oh-my-goodness-they're-doing-to-do-what? feelings about it. Zoe doesn't need this surgery to live. So if we decided to say "forget this" and walk away, we could do that.
For Zoe, though, other options aren't great. We're already doing a lot of physical therapy each week, but that's not enough. Less invasive options like baclofen or Botox aren't great for her. Baclofen affects muscle tone all over, and her core has low tone while her legs and arms have high tone, so it would hinder the muscle development in her trunk which she has fought hard to gain. Botox can help but it's also toxic in high doses; dosing is determined by a child's weight, and Zoe is so petite that her safe Botox dose is too low to target all the muscle groupings that could use it. Plus Botox deadens all the sensory nerves in the area and not just the unhelpful ones and it wears off, so SDR is a more precise and permanent.
|also, this cute bob brought to you by SDR to prevent a tangled mess|
during the first 3 post-op days in which she has to stay lying in bed
If you're a details person, here's the link about the surgery from the team in St. Louis who will be operating on Zoe. Why St. Louis? Because their surgical team has the most experience and best success rates of anywhere in the world. If I'm going to let someone slice and dice on my kid's spinal cord, I'm not okay with anyone but the best.
|those threads in the pic? they're nerves. that's kind of a big deal.|
(source: St. Louis Children's Hospital)
We leave this Saturday the 4th, pre-op is Monday the 6th, surgery is Tuesday the 7th, and we'll be in-patient until the 12th. If all goes well, we'll fly home the 13th and begin post-surgery therapies here the next day. Lee will hold down the fort with the other five kiddos here, working during school hours while Patu has daily playdates with her bestie.
Following surgery, she'll have physical therapy 4-6 times a week for the first six months post-op and then 2-4 times a week for the next six months. Thankfully, Zoe's longtime physical therapist will cover 3 of those sessions, along with a new therapist for one session a week and a school-based therapist for two sessions a week once she starts her special ed preschool program on December 1. (This is all in addition to speech therapy twice a week and occupational therapy once a week. Thankfully, Zoe loves one-on-one attention, so she thinks her loaded therapy schedule is pretty awesome.)
In other words, this surgery is a pretty big deal. Prayers, warm thoughts, encouraging texts, and the like are appreciated!