Rewiring My Brain: SLAD-R Surgery

After doing a good bit of research, it became apparent to me that the highest probability of actually fixing the bane of my existence, i.e. terminating my Spasmodic Dysphonia, was through surgery.  But not just any surgery, and not just any surgeon.  This post will cover the surgery, called SLAD-R.  The next post will cover the surgeon.

The Surgery

There are several different surgical procedures people have used to address Spasmodic Dysphonia, with varying degrees of success.  The surgery I selected is called Selective Laryngeal Adductor Denervation-Reinnervation (SLAD-R).  To understand what it is, let’s first understand the problem it’s fixing.  Basically, a part of the brain is somehow jacked up, such that it misfires and signals specific nerves to tell the vocal chords to do things they should not.  This results, for example, in the vocal chords tightening – alot – when they shouldn’t.  The upshot of which is strangled, fragmented, sometimes unintelligible speech.

So how did the surgery address this?  First, remember I was under general anesthesia, so it was lights out. Night night. Once I was under, the surgeon made an incision in my neck. (That probably sounds better than “the surgeon slit my throat.”  Doesn’t have quite the same visceral impact though.)   In any case, this must be done to get access to the nerves.

Next, he severed 2 nerves that connect the brain to the vocal chords and are the source of the problems.  For any medical geeks that are interested, the nerves are called Recurrent Laryngeal Nerves (one on the right and one on the left of the larynx).  This is the “denervation” part of the process.


After that, he basically rewired me by building a new route from my brain to my vocal chords. He took a pair of other nerves (I believe the ANSA cervicalis nerves), that had not been involved in any of the nefarious strangulation activity, and connected them to the cut stumps of the denervation process above.  This rewiring is the “reinnervation” process.

The surgery took about 3 hours, which is pretty typical.

As I learned a bit more about the  human anatomy, I found that the area in which these nerves are located seems to be pretty densely packed with all sorts of fun stuff like key arteries, as well as paths to the brain controlling important functions.  Needless to say, you don’t want somebody mucking around in there that doesn’t know their way around really well.  You want somebody that has done this many, many times, and understands the intricacies of what to do, how to do it, and how to recover when things don’t go as planned.  My next post will expand on this.

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8 thoughts on “Rewiring My Brain: SLAD-R Surgery

  • Thank you for the “medical geek” terminology Mr. Huitema 😉 Very complex and risky surgery indeed. There is only ONE doctor out there I would allow to do this operation on me or a loved one.

  • Thanks for this, just wondering if you know anything about the brain just finding a way around this & going back to the SD ? Also had you considered / know about as a comparison the Thyroplasty procedure? Thanks, am just hungry for info. Kae

    • Hi Kae,
      – Regarding finding a way around the severed nerves: my understanding is that the reinnervation process, i.e. connecting the ansa cervicalis nerves to the severed Recurrent Laryngeal Nerves, prevents the affected/ denervated nerve from reconnecting and the spasms from returning. I believe the issue is that the brain sends the bogus signals to those specific nerves. So its kind of a package deal, with 2 parts…essentially a transmitter and receiver: 1) the brain (transmitter) , and 2) recurrent laryngeal nerve (receiver). By breaking the linkage, the problem gets fixed.
      – Regarding Thyroplasty, I simply have not heard anywhere near the same number of positive experiences. Also, this research document did not paint a very pretty picture: Do note, however, that it is a dozen years old, so more contemporary research may paint a different picture.

  • Thanks for your help in helping us slad-r survivors spreading the word about how much this has helped us! My blog is and I am willing to speak or write to anyone interested!

  • I am grateful to all of you giving a voice to viable solutions, to those of us with this disorder. I believe I will be seeking out SLAD-R surgery for my AD SD, also. Spasmodic Dysphonia is very debilitating. It prevents basic communication. It isolates those that have it. It takes a lot to get a diagnosis, as too few are aware of this neurological disorder that I am told is now classified as a neurological disease.

    • Hi Kari, I think you owe it to yourself to at least have a consultation with Dr. Berke to get your questions answered directly from the horses’s mouth. There is a lot of rumor, innuendo, mythology, and just bogus info floating around. When I went to see him, I had some very specific questions based on quite a bit of research and his responses obviously made me comfortable enough to move forward.

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