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Selective dorsal rhizotomy

Selective dorsal rhizotomy

Selective dorsal rhizotomy (SDR) is a neurosurgical procedure developed to reduce spasticity, or overly tight muscles, associated with cerebral palsy (CP). This surgery can permanently reduce spasticity, increase motor control and improve movement. When performed at an early age, SDR can reduce the number of orthopaedic surgical procedures patients may require.

Currently, it is not possible to operate on the brain and correct the brain damage of CP. However it is possible to operate on the sensory nerves that come from the spastic muscle. During SDR, each sensory nerve root is divided into nerve rootlets. Cutting abnormally functioning rootlets interrupts the abnormal information coming from the muscle to the brain. Once the muscle tone decreases, it is easier for a child to improve motor skills such as sitting, crawling, standing and walking.

Candidates for SDR surgery must be chosen very carefully. Not every child with spastic cerebral palsy can benefit from SDR. Ideal candidates are children who:

  • Have a history of prematurity
  • Have had little or no orthopaedic surgery
  • Have abnormal muscle tone due to spasticity (primarily in the legs), which interferes with function or daily care
  • Are between the ages of 4 and 10
  • Can participate an intense rehabilitation program

Once your child has been determined to be a good candidate, an appointment will be made for SDR evaluation with our team.

After surgery, your child will start an intense rehabilitation program, which includes physical and occupational therapy. Post-operative rehabilitation is necessary to regain strength and improve walking and function. SDR allows patients to use muscles that were otherwise not being used properly because of spasticity. Once spasticity is reduced, children have an opportunity to gain strength and flexibility.

Long-term outcomes and realistic expectations

It is important to realize that the SDR surgery does not cure CP or spasticity. It is a treatment option to manage abnormal tone and tight muscles. Your child may continue to have difficulty with balance and coordination. Outcomes vary from child to child, but most children will experience:

  • more energy-efficient gait;
  • less toe pointing with walking;
  • improved posture;
  • improved sitting and standing balance;
  • improvement in independence in everyday living skills; and
  • decreased dependence on walking assistive devices.

SDR does not totally eliminate the need for further orthopaedic surgery. However, the combination of SDR to reduce spasticity and orthopaedic surgery to correct deformities of the muscles or bone produce a better overall outcome than either procedure done alone.

Who your child may see for this condition:

Albert Tu, M.D.

To schedule an appointment, call new patient intake at 612-596-6105.