Selective dorsal rhizotomy (SDR) is the most common nerve surgery for symptoms related to cerebral palsy (CP). During SDR, a surgeon cuts the skin over the lower part of the spinal cord. The surgeon then finds and cuts the nerves in the cord that are causing muscle tightness in the legs.

What To Expect After Surgery

After surgery, physical therapy is needed. Also, orthopedic surgery and casts or braces may still be necessary.

Nerves that are cut during SDR do not grow back together. Sometimes not all nerves are cut, and other surgeries may be needed to cut those that remain.

Why It Is Done

Selective dorsal rhizotomy is done to relieve muscle tightness and spasticity in select children with a form of CP that severely affects the legs. The procedure may also improve the range of movement in the legs.

SDR is especially useful when cerebral palsy affects both legs but not the arms (spastic diplegia). It is not advised for people who have permanently bent joints (contractures), little strength in their limbs, or difficulty with balance.

How Well It Works

Some children have less muscle tightness (spasticity) and are able to move their legs more easily after SDR, although their legs may feel weaker and somewhat numb. Sometimes spasticity completely goes away.

This surgery may decrease the chances of leg deformities in growing children. When muscles tighten around growing bones, the bones may not develop normally.

SDR cuts the nerves that cause spasticity and helps prevent the muscle from tightening again. When SDR is done before orthopedic surgery, it may increase the success of that surgery.

Although some studies have shown that SDR can improve function (such as sitting, walking, and standing) in some children with CP, other studies are less favorable for showing improvement in long-term functional abilities. ¹

Risks

In most cases, SDR does not affect other functions of the body, such as bowel and bladder control or the ability to have sex. In rare cases, problems such as strange sensations or loss of control over the bladder can occur.

What To Think About

Complications after SDR are rare. Children need to have physical therapy for up to 1 year after this surgery.

More study is needed to determine the long-term effects of SDR on the function and condition of the bones and joints.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Citations

1. Koman LA, et al. (2004). Cerebral palsy. Lancet, 363(9421): 1619–1631.