What is selective dorsal rhizotomy?
Selective dorsal rhizotomy (SDR) is a minimally invasive spinal operation that can permanently reduce leg spasticity and encourage independent walking in children with cerebral palsy. It may be an option when other therapies, such as physical therapy or Botox injections, have stopped working.
SDR is most effective in children whose cerebral palsy is the result of being born prematurely and whose spasticity mainly affects their legs. Children with spasticity in all their limbs may get more benefit from an intrathecal baclofen pump or a combined rhizotomy surgery.
SDR normally takes about four hours and usually requires your child to stay in the hospital for four to five days.
What happens during SDR?
Once your child is asleep under general anesthesia, the neurosurgeon makes a small cut in the upper lumbar region of the spine and removes a small section of bone to expose the nerve roots as they leave the spinal cord. Looking through a microscope, the surgeon then separates the nerve roots into groups, finding those that bring sensation back from the legs and leaving the motor nerves aside.
The surgeon tests each sensory nerve root in turn by stimulating it electrically, while a specialist called an electrophysiologist monitors the response in your child's leg muscles. If the nerve responses are abnormal, these nerve roots may be selectively cut. After about half of the abnormal nerve roots have been cut, the surgical team leaves a temporary epidural catheter for optimal pain control and then carefully closes the wound.
Who may benefit most from SDR?
We evaluate your child carefully to determine whether SDR is the best treatment option. Children are most likely to benefit from the operation if they:
- have spasticity mainly in their legs
- can walk on their own or with the help of a walker or braces, or have the potential to do so
- are physically and mentally able to participate in intensive physical therapy after the operation
- are motivated and able to follow instructions
SDR may be less beneficial if your child has a great deal of spasticity in their arms or requires support to sit up. You should speak with your child's neurosurgeon and cerebral palsy care team about all available options.
What happens after SDR?
Most children return to their baseline level of mobility about one to two weeks after surgery. Because the operation releases tone in the muscles, they will have noticeably less spasticity right away. Once spasticity is reduced, however, the underlying muscle weakness becomes more obvious. This means that your child will feel weaker at first and will need to gradually regain muscle strength through intensive physical therapy. We recommend at least five physical therapy sessions a week for at least six weeks. This typically occurs in a specialized inpatient rehabilitation center with expertise in SDR patients. With this schedule, most children will have greatly improved strength and gait within six months.
Results depend on your child's medical status before the operation and how closely they adhere to physical therapy afterward. But overall, studies that have followed children for longer than 20 years after SDR surgery have shown long-term improvement in muscle tone. Studies also show better gait and greater mobility five to 10 years after the operation, and greater improvements when compared with intensive physical therapy alone.