Of all the surgical procedures currently performed on patients with cerebral palsy (CP), selective dorsal rhizotomy (SDR) has undergone more thorough scientific scrutiny than any other (including orthopedic surgery).
The technique used in St Louis involves surgery in the lower back. The procedure concentrates on the lower part of the spinal cord. An ultra-sound probe is used to identify the lower end of the cord. Each of the sensory nerve roots at the lower end of the spinal cord is subdivided into four or five rootlets. The rootlets that contribute most to the spasticity are indentified and divided. Some of these nerve roots are cut, before the cover of the spinal cord is closed again and the skin closed with absorbable sutures.
SDR unmasks the muscle weakness inherent to cerebral palsy. After surgery intensive physiotherapy is needed to rebuild strength and allow the child to learn to use his / her body in a new way. However, it becomes apparent with time that lower limb movement can become easier and both control and speed increase. It can take up to two years for the full benefit of the procedure to become apparent.
There is now enough evidence to demonstrate that SDR is associated with long-term benefits. One study has shown that the benefits obtained one year after SDR were maintained after twenty years. A reduction in the need for orthopaedic procedures after early SDR has also been demonstrated.
More information on SDR can be found on the St Louis Children’s Hospital Website.