On Their Own Two Feet

By Sanjay Gupta, M.D. Sunday, Feb. 17, 2002
    • Cindy Hickman nearly bled to death the day she gave birth--three months prematurely--to her triplet sons. Weighing less than 2 lbs. each, her babies were alive, but barely. They clung so tenuously to life that her doctors recommended she name them A, B and C. Then, after a year of heroic interventions--brain shunts, tracheotomies, skull remodeling--often requiring emergency helicopter rides to the hospital nearest their rural Tennessee home, the Hickmans learned that their triplets had cerebral palsy.

    Fifteen years ago there wasn't much that could be done about cerebral palsy, a disorder caused by damage to the motor centers of the brain. But pediatric medicine has come a long way since then, both in intervention before birth, with better prenatal care and various techniques to postpone delivery, and surgical interventions after birth to correct physical deficiencies. So although the incidence of cerebral palsy seems to be increasing (because the odds of preemies surviving are so much better), so too are the number of success stories.

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    This is one of them. Lane, Codie and Wyatt (as the Hickman boys are called) have spastic cerebral palsy, the most common form, accounting for nearly 80% of cases. "We first noticed that they weren't walking when they should," Cindy recalls. "Instead they were only doing the combat crawl." Their brains seemed to be developing age appropriately, but their muscles were unnaturally stiff, making walking difficult if not impossible.

    Happily, spastic cerebral palsy is also the most treatable form of CP, largely thanks to a procedure known as selective dorsal rhizotomy, in which the nerve roots that are causing the problem are isolated and severed. Among the first to champion SDR in the U.S. in the late 1980s was Dr. T.S. Park, a Korean-born pediatric neurosurgeon at Washington University in St. Louis, Mo., who has performed more than 800 of these operations and hopes to do an additional 1,000 before he retires.

    Having performed the operation myself as a resident in neurosurgery, I was eager to see how the country's most prolific SDR surgeon does it. Last month I got an opportunity to stand by his side as he operated on 3-year-old Lane Hickman.

    Peering through a microscope and guided by an electric probe, we were able to distinguish between the two groups of nerve roots leaving the spinal cord. The ventral roots send information to the muscle; the dorsal roots send information back to the spinal cord. The dorsal roots cause spasticity, and if just the right ones are severed, the symptoms can be greatly reduced.

    Nearly half a million Americans suffer from cerebral palsy. Not all are candidates for SDR, but Park estimates that as many as half may be. He gets the best results with children between ages 2 and 6 who were born prematurely and have stiffness only in their legs. He is known for performing the operation very high up in the spine, right where the nerve roots exit the spinal cord. It's riskier that way, but the recovery is faster, and in Park's skilled hands, the success rate is higher.

    Cindy and Jeremy Hickman will testify to that. Just a few weeks after the procedure, two of their sons are walking almost normally and the third is rapidly improving.

    For more on the Hickman triplets, watch Your Health on CNN at 2:30 E.T., Saturday, Feb. 23