Selective dorsal rhizotomy (SDR) is a surgical procedure used to treat spasticity in children with cerebral palsy (CP).

Spasticity is a problem with the central nervous system that results in over-firing of certain muscles causing stiffness and difficulty with fluid movement.

During the SDR surgery, the surgeon tests the patient’s nerves to determine which ones are causing the spasticity. These nerve roots are then carefully cut. The results of this surgery are permanent and the goal is to improve the patient’s overall motor function. 

Because this surgery is not reversible, SDR is not appropriate for all children with CP.  Your child must go through a screening process to determine if this procedure is appropriate for them. Among other criteria, he or she must:

• Have a diagnosis of spastic diplegia or spastic quadriplegia and exhibit the typical signs and symptoms
• Be at least two years of age
• Have no significant damage to the basal ganglia (certain part of the brain)
• Be able to support his or her body weight in standing

Once approved for the procedure, your child will be evaluated by a physical therapist to determine his or her baseline level of function. This will serve as a starting point for therapy following the procedure and provides a way to measure the success of the surgery. 

After surgery, your child will receive physical therapy services to gradually improve:

• Flexibility
• Joint range of motion
• Strength
• Gross motor function

Immediately following surgery, you can expect that your child may need to wear ankle or foot braces (AFOs) and knee immobilizers for long periods of time. 

While in the hospital, the therapist will help teach you a home exercise program and movement precautions to protect the surgical site. Physical therapy outside of the hospital will focus on:

• Strengthening
• Mobility
• Range of motion

The rhizotomy team will work together with the physical therapist to determine the appropriate amount of therapy needed to achieve the best results following the surgery.  

Physical Therapy Treatment

Physical therapy treatments following surgery include: