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Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

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How to approach histology for Human Anatomy students. Using a key will help get you through it! Add some penguin fairy dust will help too!

Please note: I mis-spoke and said "striated" instead of "stratified epithelium" a couple of times... apologies!

There are lots of histology keys out there, but the one I showed in the video is here: http://www.penguinprof.com/upl....oads/8/4/3/1/8431323

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Tissue in the human body:

Epithelial: Is made of cells arranged in a continuous sheet with one or more layers, has apical & basal surfaces.

A basement membrane is the attachment between the basal surface of the cell & the underlying connective tissue.

Two types of epithelial tissues: (1) Covering & lining epithelia and (2) Glandular Epithelium.

The number of cell layers & the shape of the cells in the top layer can classify epithelium.

Simple Epithelium - one cell layer
Stratified epithelium - two or more cell layers
Pseudostratified Columnar Epithelium - When cells of an epithelial tissue are all anchored to the basement Membrane but not all cells reach the apical surface.
Glandular Epithelium -- (1) Endocrine: Release hormones directly into the blood stream and (2) Exocrine - Secrete into ducts.


Connective: contains many different cell types including: fibroblasts, macrophages, mast cells, and adipocytes. Connective Tissue Matrix is made of two materials: ground substance - proteins and polysaccharides, fiber -- reticular, collagen and elastic.

Classification of Connective Tissue:
Loose Connective - fibers & many cell types in gelatinous matrix, found in skin, & surrounding blood vessels, nerves, and organs.
Dense Connective - Bundles of parallel collagen fibers& fibroblasts, found in tendons& ligaments.
Cartilage - Cartilage is made of collagen & elastin fibers embedded in a matrix glycoprotein & cells called chondrocytes, which was found in small spaces.
Cartilage has three subtypes:
Hyaline cartilage -- Weakest, most abundant type, Found at end of long bones, & structures like the ear and nose,
Elastic cartilage- maintains shape, branching elastic fibers distinguish it from hyaline and
Fibrous Cartilage - Strongest type, has dense collagen & little matrix, found in pelvis, skull & vertebral discs.


Muscle: is divided into 3 categories, skeletal, cardiac and smooth.
Skeletal Muscle -- voluntary, striated, striations perpendicular to the muscle fibers and it is mainly found attached to bones.
Cardiac Muscle -- involuntary, striated, branched and has intercalated discs
Smooth Muscle -- involuntary, nonstriated, spindle shaped and is found in blood vessels & the GI tract.


Nervous: Consists of only two cell types in the central nervous system (CNS) & peripheral nervous system (PNS):
Neurons - Cells that convert stimuli into electrical impulses to the brain, and Neuroglia -- supportive cells.
Neurons -- are made up of cell body, axon and dendrites. There are 3 types of neurons:
Motor Neuron -- carry impulses from CNS to muscles and glands,
Interneuron - interpret input from sensory neurons and end responses to motor neurons
Sensory Neuron -- receive information from environment and transmit to CNS.
Neuroglia -- is made up of astrocytes, oligodendrocytes, ependymal cells and microglia in the CNS, and schwann cells and satellite cells in the PNS.

Polio virus

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Men and women have anatomical differences when it comes to genitals, but orgasms are fundamentally very similar. The female orgasm lasts longer than the male, ranging about 20 seconds compared to 3 to 10 seconds, but men do experience more orgasms.

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Medial medullary syndrome, also known as Dejerine syndrome, represents less than 1% of brainstem stroke syndromes. Thrombotic or embolic occlusion of small perforating branches from vertebral or proximal basilar artery supplying the medial aspect of medulla oblongata cause this rare syndrome. It is characterized by contralateral hemiplegia/hemiparesis as well as hemisensory loss with ipsilateral hypoglossal palsy (ipsilateral tongue weakness and atrophy) from involvement of CN XII nucleus. Other manifestations e.g. vertigo, nausea, ipsilateral limb ataxia are also reported.

When oral medications do not relieve knee pain, but you're not to the point of pursuing knee surgery, one of the following injections or procedures may help. Hyaluronic acid supplements – Although not technically medications, these substances are injected into knee joints to supplement naturally occurring hyaluronic acid. In healthy joints hyaluronic acid acts as a shock absorber and lubricant, allowing joints to move smoothly over each other. However, the acid appears to break down in people with osteoarthritis. Injecting it into a joint may lessen pain and inflammation. The injections are given weekly for three or five weeks, depending on the product (examples are Synvisc and Hyalgan). A small amount of joint fluid is removed first to make room for the hyaluronic acid. Corticosteroid Injections – Doctors sometimes inject corticosteroids directly into the knee joint for quick relief of pain and inflammation. Their benefits may last anywhere from a few days to more than six months. While the injections bring targeted relief to the joint and lack many of the side effects of oral corticosteroid medications, they are not without risks. Repeated knee injections may actually contribute to cartilage breakdown. For that reason your doctor will likely put a limit on the number of injections you can receive. Read a report from the British Medical Journal on corticosteroid injections for knee osteoarthritis. Arthrocentesis – Also called joint fluid aspiration, arthrocentesis is removal of joint fluid through a hollow needle inserted into the joint space of the knee. Although the purpose of removing joint fluid from the knee is usually so that it can be tested in the lab, removing excess fluid can also quickly ease pain and swelling. Often after withdrawing fluid, doctors use the same puncture site where the fluid was removed to inject a corticosteroid preparation and/or anesthetic into the knee joint to further relieve pain and inflammation.

A grand mal seizure causes a loss of consciousness and violent muscle contractions. It's the type of seizure most people picture when they think about seizures. A grand mal seizure — also known as a generalized tonic-clonic seizure — is caused by abnormal electrical activity throughout the brain. Usually, a grand mal seizure is caused by epilepsy. But sometimes, this type of seizure can be triggered by other health problems, such as extremely low blood sugar, a high fever or a stroke. Many people who have a grand mal seizure never have another one and don't need treatment. But someone who has recurrent seizures may need treatment with daily anti-seizure medications to control and prevent future grand mal seizures

Blood is a specialized fluid in your body that has four main components, each with a different function: plasma, red blood cells, white blood cells, and platelets.