Selective Dorsal Rhizotomy Procedures

What is a Selective Dorsal Rhizotomy?

Selective dorsal rhizotomy is a nerve surgery that permanently decreases high muscle tone, or spasticity. During a rhizotomy, a surgeon cuts specific nerves in the spinal canal contributing to the child’s spasticity. A multi-disciplinary team of experts – including pediatric specialists in neurosurgery, physical medicine and rehabilitation, orthopedics, neurology, physical therapy and others – evaluates each child and their specific needs and goals. This may involve assessment in our state-of-the-art Motion Analysis Lab, which gives detailed information on a child’s gait that helps guide decision making. 

Several different variations of the rhizotomy procedure may be tailored to each child’s needs. Discussions with our Spasticity Management care team help patients and families choose the procedure that works best for them.

Types of Rhizotomy Procedures

At Texas Children’s Hospital, the most common rhizotomy procedures performed are: 

• Selective Dorsal Rhizotomy (SDR) 
  • Full SDR 
  • Focal SDR
• Palliative Rhizotomy 

A summary of each procedure’s goals, qualifications, method, incision size and recovery expectations are shown in this table.

We’ve described the procedures in greater detail here:

Full Selective Dorsal Rhizotomy

In a full selective dorsal rhizotomy (SDR), the surgeon accesses the nerves that supply the leg muscles (L2 to S1). This is done via laminoplasty, or temporarily opening the vertebrae from the back. Selective means that the neurosurgeon cuts specific nerve roots at the levels causing the spasticity. Dorsal refers to the location of the nerves in the spinal canal. The dorsal nerves have small branches called “rootlets” that send messages toward the spine. During surgery, these rootlets are stimulated, and the most abnormal rootlets are cut. This decreases the spasticity reflex loop and relaxes muscles in the legs. Nerve monitoring during surgery keeps unaffected nerves safe. 

After recovering for a few days after surgery, patients are transferred to Texas Children’s Inpatient Rehabilitation Unit to continue strengthening and gait training. In appropriate candidates, this surgery can be transformative in improving a child’s gait, allowing them to walk with greater independence and ease.

Is a selective dorsal rhizotomy the right procedure for your child? 

It can be the right solution for children with high muscle tone. Your health care team will guide you through the decision process. The child’s likelihood of meeting an SDR surgery’s goals are shown in this overview:

View of a Full SDR

Focal Selective Dorsal Rhizotomy

A focal SDR is a minimally invasive method of reducing tone in only one or two nerve levels. Children who require spasticity reduction in only a few muscles, typically at the ankle or knee, may be candidates for focal SDR. Through a 1-inch incision, the surgeon removes a tiny piece of bone and uses a small tube to access, view, and cut nerve rootlets at 1 or 2 nerve levels. Children usually recover from this surgery in 1 to 2 days, then participate in our Acute Outpatient Rehabilitation Program.

Focal SDR may be performed simultaneously to orthopedic surgery, such as heel cord release. This allows the child to recover from both procedures at the same time and undergo only one operation. This procedure has broadened access to the benefits of rhizotomy to a wider group of patients. This includes patients with diverse etiologies of spasticity, older kids and young adults, and patients with a range of cognitive capabilities.