Selective Dorsal Rhizotomy Surgery for Spasticity

About selective dorsal rhizotomy surgery and cerebral palsy

Selective dorsal rhizotomy (SDR) is a surgery that reduces spasticity, or tightness, in the muscles of the lower extremities (legs). The goal of surgery is to improve the long-term quality of life for kids with spasticity, often caused by cerebral palsy.

If you are considering SDR as a treatment option for your child’s cerebral palsy, your child will see multiple pediatric specialists for an initial evaluation at Children’s Hospital Colorado. After the evaluation, provide treatment options based on your child's needs and development. At Children’s Colorado, SDR is performed by a pediatric neurosurgeon who specializes in rhizotomy surgery.

How does cerebral palsy cause spasticity and muscle tightness?

Ordinarily, nerves carry information from muscles to the spinal cord and back again. This information tells the muscles to contract (tighten) or relax (loosen) appropriately.

In a child with spasticity, abnormal signals are sent from the muscles to the spinal cord and back again, which causes the muscles to contract or tighten and not relax appropriately.

How can selective dorsal rhizotomy surgery help my child?

Selective dorsal rhizotomy surgery is done by cutting some of the tiny nerve rootlets carrying information from the leg muscles before the rootlets enter the spinal cord. In children with spasticity, this reduces the number of abnormal signals that are sent from the leg muscles to the spinal cord. As a result, there is less tightness in the lower extremities.

Benefits of this surgery may include:

• Decreased need for surgeries of the hips and lower extremities (legs)
• Decreased leg pain
• Easier dressing and care
• Improved sitting balance, longer stride length and easier walking
• Fewer falls
• Better function and movement of the upper body

Who is eligible for this surgery?

Not every child with cerebral palsy benefits from a rhizotomy. A team of specialists including a neurosurgeon, rehabilitation physician, neurologist, physical therapist and a rehabilitation nurse evaluate potential candidates for this surgery.

Although there are exceptions, patients who are eligible for this surgery generally:

• Are between the ages of 4 to 10 years old
• Have spasticity in the lower extremities
• Have good underlying leg strength and control
• Have good cognitive development and motivation
• Are able to complete the intense rehabilitation needed after surgery

What to expect before selective dorsal rhizotomy surgery

Before surgery, our team will complete a thorough history and exam of your child. Tests may include:

• Magnetic resonance imaging (MRI) 
• Lab work
• Physical therapy evaluation
• A Gait Lab video evaluation to evaluate walking ability

Also during this time, a clinical social worker will meet with each family to provide support. We encourage your family to take a pre-surgery tour to decrease anxiety and answer any questions.

During the surgery, the neurosurgeon makes an incision along the center of the lower back. The posterior part of the spine is opened and the spinal cord is exposed. Then, the surgeon locates the nerve roots that exit from the lower spinal cord.

The nerve roots that send signals to the spinal cord about muscle tone (called sensory roots) are separated from the others (called motor roots), and then divided into smaller strands called rootlets.

Each rootlet is electrically stimulated and the response is monitored. The rootlets producing the most abnormal muscle contractions are cut.

Finally, the surgeon closes the spine and the incision.

Rehabilitation after surgery

Children with cerebral palsy know what movement patterns work for them and what feels “normal.” The main goal of therapy is to help children learn how to move with muscles that may feel looser and weaker after surgery.

For the first 48 hours after surgery, your child will be on bed rest, and he or she will then be transferred to the Inpatient Rehabilitation Unit at Children’s Colorado where therapy will begin. While in the hospital, your child will work with a:

• Physical therapist
• Occupational therapist
• Social worker
• Psychologist
• Educational specialist (teacher)
• Speech therapist
• Therapeutic recreational therapist

Because your child’s muscles may feel weaker, the first two weeks of therapy will focus on floor mobility and transfers, then walking in parallel bars or with a walker before walking on their own.

A wheelchair may also be used early on and for longer distances. If your child wore orthotics prior to surgery, he or she may continue wearing them after surgery. We also use knee immobilizers to help stretch the hamstrings while your child lies in bed.

Before leaving the hospital, your care team will find an outpatient therapy program if you do not already have one established. Discharge usually occurs between four and six weeks after surgery. Intensive outpatient physical therapy is recommended at least twice a week for the first year after surgery.

Why choose Children’s Colorado for the selective dorsal rhizotomy surgery?

Children’s Colorado believes in treating the entire child – not just the illness. Our team-based approach ensures that all the child’s health needs are being met at one time and in one place. This is especially important after selective dorsal rhizotomy surgery, when intensive physical and occupational therapy is needed. During each visit to the clinic, your child will see specialists including a:

• Pediatric neurosurgeon who specializes in selective dorsal rhizotomy surgery
• Pediatric rehabilitation physician
• Pediatric neurologist who specializes in movement disorders
• Physical therapist
• Rehabilitation nurse

Continued care and follow-up treatment

Patients and families visit Children’s Colorado several times during the first year after surgery and then at least once a year for several years after surgery. Our team follows your child’s progress, evaluates any problems, makes care suggestions, answers questions from you and from your child’s therapists, and provides ongoing support.

Specific conditions treated

• Cerebral palsy
• Spasticity

Carson's selective dorsal rhizotomy surgery