From Walking Funny to Riding a Bike: Patient with Cerebral Palsy Travels from Minnesota to Cincinnati for SDR Surgery

Vincent Kandravi was 2 years old when he began having problems with his gait. At first, he was just “walking funny” with a flat foot. But over the next six months, he began tripping and having trouble going down stairs.  

Vincent’s pediatrician where they live in Minnesota referred his mother, Lizzie, to a physical medicine and rehabilitation (PM&R) specialist, who did a thorough evaluation and diagnosed Vincent with spastic cerebral palsy (CP).

Lizzie and her husband, Joe, were shocked at first but quickly went “all in” on the recommended rehabilitation regimen to treat Vincent’s spasticity. This included casting to stretch his ankle to 90 degrees in preparation for an ankle-foot orthotic, then adding a knee immobilizer to achieve better ankle extension. 

Vince also did occupational therapy (OT) and physical therapy (PT) for two years. However, by the spring of 2020, his leg muscles were still very tight.

“Walking was an effort for Vincent—with every step, he had to hike up his right hip and pop his foot down, and he couldn’t clear his right foot with each step,” Lizzie said. 

“Looking back, I realize how exhausting it must have been for him. At 4 years old, he slept 12 hours a night and took a two-and-a-half-hour nap every day.”

Botox injections helped temporarily relax Vincent’s muscles and improve his ability to walk. But Lizzie and Joe were nervous about potential side effects, as well as the need for repeated injections once the benefit wore off after a few months. When their PM&R specialist mentioned the possibility of selective dorsal rhizotomy (SDR) surgery at Cincinnati Children’s, they were immediately intrigued. 

Aimed at permanently reducing spasticity in the legs, SDR is a complex — but safe — procedure that allows patients like Vincent to improve their walking and independent mobility.

Evaluation at Surgical Spasticity Clinic

The family traveled to the Cincinnati Children’s Surgical Spasticity Clinic in July 2021 for a two-hour evaluation with a multidisciplinary team of experts, including a pediatric neurosurgeon, PM&R physician, and physical therapist. 

“Everyone was in the same room at the same time discussing what would be best for Vincent,” Lizzie said. “It was so collaborative—they made us feel like we were part of the decision-making process. We all agreed that SDR could address the miscommunication between Vincent’s brain and muscles that was preventing him from walking normally." 

The Kandravis decided to move forward with pediatric neurosurgery at Cincinnati Children’s after learning that SDR would provide better long-term control of his spasticity. Their local care team performed imaging studies and a gait analysis to assist the surgery team at Cincinnati Children’s in their planning process. 

Pediatric neurosurgeon Charles Stevenson, MD, performed the SDR surgery, which took place in Cincinnati in January 2022.

“SDR is an ideal treatment option for patients like Vincent whose walking is negatively impacted by spasticity in the muscles of the lower extremities,” explained Dr. Stevenson. 

The surgery is performed through a small incision (approximately 1 to 1.5 inches), allowing for a quick recovery and immediate reduction in spasticity.

“Parents can feel the difference in their child’s leg muscles the very same day of the procedure,” said Dr. Stevenson. “Prior to surgery, Vincent literally had to fight his spastic leg muscles with each and every step. By relieving the spasticity in those muscles, SDR allows him the freedom to begin building strength and increasing range of motion in the legs.”

Vincent remained at the hospital for five days. By the time they boarded the plane back home Lizzie could tell he was moving more easily.

Vincent Returns Home with Specialized Physical Therapy Protocol

A week later, Vincent arrived at his PT appointment without his walker and began the next phase of his recovery.

Experts at Cincinnati Children’s agree, PT is critical for patient success in the post-SDR period. Improving mobility following SDR is a 2-step process, with surgery as the first step, said Dr. Stevenson. 

"It takes only a few hours and is the easy part. It immediately ‘levels the playing field’ for the patient by reducing their spasticity," he said. "The second step is harder and unarguably more critical." 

Working with their PT, patients must build strength in their legs and improve the efficiency of their gait.

"As with anything, improvement comes with practice, and practice takes time and commitment," said Dr. Stevenson. "It is of the utmost importance that patients work hard in therapy for several months following SDR for them to realize the full benefits of the surgery." 

As part of Vincent’s ongoing treatment, a physical therapist from Cincinnati Children’s shared a specialized protocol with Vincent’s local PTs. 

The goal? To help Vincent “retrain his brain” so he could improve his gait and mobility, now that the spasticity in his legs was significantly reduced.  

At first, Vincent participated in PT four days a week, later reduced to just two days a week. His last appointment was in July 2022. 

“SDR made a world of difference for Vincent—he can run, jump and go down stairs easily, and he even taught himself to ride a bike!” says Lizzie. “He’s done with naps and only needs 10 hours of sleep a night. I love seeing how much self-confidence he has now." 

Lizzie hopes more children can benefit from CP interventions available at specialty centers like Cincinnati Children’s. She adds: “It’s been a life-changing experience for our family, and we’re grateful.”