Copyright © 2019 Albuquerque Journal
Claudia Avalos keeps a video clip of her son on her cellphone – an image of a happy 13-year-old taking labored steps on the balls of his feet, heels never touching the ground, legs permanently bent, hunched forward and clutching a metal walker.
That posture changed on July 18, when Jacob Avalos, who has had cerebral palsy since birth, became the first person in New Mexico to have a surgical procedure that minimizes spasticity in his legs, a condition characterized by continuously contracted muscles and tightness that interferes with his ability to walk normally.
“Almost immediately after the surgery, I could tell his legs were relaxed, stretched out, straighter, and his heels touched the floor,” his mom said. “I’m 5 feet tall, and Jacob used to come up to under my chin when he was standing. Now he’s almost as tall as me.”
Jacob is undergoing intensive physical therapy at the University of New Mexico Children’s Hospital, where the procedure, called selective dorsal rhizotomy, or SDR, was performed by Dr. James Botros, a pediatric neurosurgeon and an assistant professor at the UNM Health Sciences Center. The procedure involves severing specific nerves coming out of the spine.
“Jacob never really had much muscle in his legs and relied on the tightness to move and walk,” Avalos said. “Now that the tightness is gone, the physical therapy is helping to build those muscles so that he can eventually carry himself unassisted.”
Jacob, born prematurely at 27 weeks and weighing just 2 pounds, experienced a brain bleed that led to cerebral palsy, his mother said.
“The doctors told us he wouldn’t be able to walk, talk, hear or see, and he does have issues with his eyes. He is considered legally blind and he is developmentally delayed, but he is very smart and very conversational. In therapy, he is often told to stop talking and keep walking.”
The Avalos family, who lives in Las Cruces, also includes husband Adrian Avalos, a truck driver, and 10-month-old daughter Camila. They learned of the SDR procedure while attending a pain management clinic at UNM Hospital.
Botros, who has been at UNM Hospital for one year, and a multidisciplinary team, assessed Jacob and determined he was an “ideal candidate for this type of surgery,” said Botros, 34. He is between the ages of 5 and 18, has cerebral palsy with spasticity that primarily affects the legs, and is willing and able to participate in postoperative rehabilitation and physical therapy.
As part of SDR surgery, Botros removed a piece of bone from Jacob’s spine to expose the bundle of nerves that supply sensation to his legs.
“We separate each nerve, which is then further divided into different segments, and each of those segments is stimulated,” Botros said. “The most overactive ones are sacrificed, interrupting the circuit that results in spasticity. The goal is to lower the muscle tone and reduce spasticity without causing new weakness or new numbness, and sparing the motor nerves that provide strength.”
Ultimately, the goal for Jacob is to be able to walk unassisted, and his prognosis toward that goal is “excellent,” Botros said.
Although SDR surgery is not new, “the reason it has not been done in New Mexico before is because not all pediatric surgeons are trained to do it,” Botros said. “The other issue is with patient selection, which is why it’s so important to have a multidisciplinary team and identify and shepherd patients through the process.”
That process involves up to six weeks of intensive post-surgical physical therapy and then, when the child goes home, a rehabilitation plan that can last up to two years.
Botros was born and raised in Cleveland to parents who were both accountants. Always interested in science and with a goal set early on to become a doctor, he studied neuroscience at Boston University and got his medical degree from Washington University in St. Louis. He completed a seven-year neurosurgery residency at the University of Texas Southwestern in Dallas and then a one-year pediatric neurosurgery fellowship at the University of Southern California in Los Angeles before going to UNM Hospital.
The perpetually smiling Jacob, however, doesn’t dwell on medical credentials or the technical aspects of neurosurgery.
“Physical therapy is very hard – not painful, just difficult,” he said. “I’m doing it because I want to walk.”