Selective Dorsal Rhizotomy (SDR) is a highly specialized neurological surgical procedure designed to reduce spasticity, which is a condition characterized by increased muscle tone or stiffness, commonly affecting the lower limbs.
Spasticity often results from neurological conditions such as cerebral palsy, spinal cord injury, or other disorders that disrupt normal nerve signals between the brain and muscles.
In people with spasticity, certain nerve roots in the spinal cord send abnormal or excessive signals to the muscles, causing them to contract involuntarily and become tight. This can lead to difficulties with movement, balance, and walking.
The goal of SDR is to selectively cut or remove some of these problematic sensory nerve rootlets in the lower spine (dorsal roots) that contribute to the increased muscle tone. By doing so, the surgery interrupts the abnormal nerve signals causing spasticity, helping the muscles relax and allowing for improved voluntary control of movement.
The Surgery is performed under general anesthesia.
- The surgeon makes an incision in the lower back to expose the spinal cord and nerve roots.
- Using specialized techniques and intraoperative monitoring, the surgeon carefully tests the nerve rootlets to identify which ones are responsible for the spasticity. Only those nerve rootlets that contribute to the abnormal muscle stiffness are cut, while preserving those necessary for normal sensation and movement. This precision is crucial to avoid causing weakness or sensory loss.
SDR is most commonly performed in children with spastic cerebral palsy, especially those who have good muscle strength but suffer from severe spasticity that affects their mobility.
The surgery is less commonly performed in adults because rehabilitation is intensive and involves relearning motor skills, which is easier and more effective at a younger age.
Early intervention can maximize long-term functional improvement.
SDR requires a significant commitment to post-operative rehabilitation. After surgery, patients usually stay in the hospital for a few days for pain management and monitoring. Physiotherapy starts soon after surgery, focusing initially on gentle movements and preventing complications.
Children who undergo SDR often show improvements in walking ability, reduced need for muscle relaxant medications, and an overall better quality of life. However, since the surgery is irreversible, the decision to proceed requires careful consideration.
- Strengthening muscles that may have been weak or underused before surgery.
- Improving balance, coordination, and walking patterns.
- Relearning basic movements and motor skills, since the nervous system’s communication with the muscles has changed.
- Preventing muscle fatigue and avoiding injuries during recovery.
Due to the complexity of the surgery and recovery, it is essential to have a multidisciplinary healthcare team involved. This team typically includes neurologists, neurosurgeons, orthopedic surgeons, specialist neurological physiotherapists, occupational therapists, and sometimes speech therapists. This team works together to evaluate candidacy for surgery, plan the procedure, and develop a personalized rehabilitation program.
Patients and families should have thorough discussions with their healthcare providers to understand the benefits, risks, and long-term commitment involved with SDR. The surgery can provide significant improvements but requires dedication to post-operative therapy and adjustment to new movement patterns.
In summary, Selective Dorsal Rhizotomy is a powerful surgical option for carefully selected patients with spasticity, aiming to improve muscle control, reduce stiffness, and enhance overall function—especially when combined with comprehensive rehabilitation support.
