selective dorsal rhizotomy
Last reviewed 01/2018
- brain nerve centres normally controlling muscle tone can be affected in
cerebral palsy. Muscle tone in such patients greatly depends on a sensory-motor
reflex arc between muscles and spinal cord nerves, causing the muscle to contract
(that is, a spastic reflex). The aim of selective dorsal rhizotomy (SDR) is
to downregulate this spastic reflex by reducing its sensory input
- SDR is a major surgical procedure performed on the lower spine. An incision
is made along the lower back and a laminectomy is made in one or more vertebrae
to uncover and then test the small nerve rootlets that make up the spinal
sensory nerves. Usually three to five rootlets are identified and those that
are found to have abnormal electromyographic responses intraoperatively are
cut. All motor nerve rootlets are preserved so that leg movement is not affected
- intensive physiotherapy and aftercare is usually given for several months
after the procedure. Patients who were previously able to walk may have to
learn different walking skills
- a NICE review states "Current evidence on selective dorsal rhizotomy for spasticity in cerebral palsy shows that there is a risk of serious but well-recognised complications. The evidence on efficacy is adequate. Therefore this procedure may be used provided that normal arrangements are in place for clinical governance and audit..
Reference: