Selective Dorsal Rhizotomy
When kids are good candidates for selective dorsal rhizotomy, it can help them tremendously. It can improve their gait and give them mobility like nothing else can. But kids need to participate with the therapy afterward. That requires a certain level of thinking and cognition and a certain amount of stamina and attitude
Shenandoah Robinson, MD, Neurosurgeon, Boston Children's Hospital
Selective dorsal rhizotomy is a neurosurgical treatment for leg spasticity—increased muscle tone and tightness that limits leg movement. This operation is sometimes recommended for children with spasticity from cerebral palsy when other treatments, like physical therapy and Botox injections, are no longer helping.
The goal of the operation is to increase mobility and encourage independent walking. Many children can transition from walkers to crutches or canes and avoid the need for other surgical procedures.
Selective dorsal rhizotomy (SDR) surgery works by calming down an over-active feedback loop between the motor nerves and sensory nerves that run between the spinal cord and the leg muscles. Our surgeons make a small incision in the lower back and cut some of the sensory nerves close to where they enter the lower spinal cord.
We use the term "selective" because only the nerves that are most abnormal are cut. We closely monitor muscle responses during the operation to ensure that the correct nerves are targeted. This allows us to reduce the excess muscle tone without affecting sensation in the child’s legs.
We use a minimally invasive approach to keep recovery time after SDR surgery as short as possible. Our neurosurgeons work closely with a multidisciplinary team of specialists including:
- Physical therapists
- Occupational therapists
- Orthopedic surgeons
- Anesthesia and pain management specialists
We also work with a team of complex care pediatricians to ensure each child’s full medical needs are met.