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
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.
References
Citations
Koman LA, et al. (2004). Cerebral palsy.
Lancet, 363(9421): 1619-1631.
Credits
| Author | Debby Golonka, MPH |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | Michael J. Sexton, MD - Pediatrics |
| Specialist Medical Reviewer | Louis Pellegrino, MD - Developmental Pediatrics |
| Last Updated | October 14, 2008 |
