Selective Dorsal Rhizotomy

Surgery Overview

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

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 may be done to relieve muscle tightness and spasticity when CP 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 usually not advised for people who have permanently stiff joints (contractures), little strength in their limbs, or problems 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.

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.

Surgery of any kind carries the risk of bleeding, infection, or the need for repeated surgery.