Selective Dorsal Rhizotomy (SDR)

To treat spasticity, children with cerebral palsy often need lifelong medication and multiple orthopedic surgeries.

Children with cerebral palsy often experience severe muscle contractions (spasticity) that make movement painful and difficult. Over time, these contractions can limit growth and lead to unusual limb development — especially in the legs.

Your child may find relief, though, with a special operation at Cook Children's called selective dorsal rhizotomy, or SDR. While SDR isn't a cure for spasticity, we can improve range of motion and overall quality of life for certain children.

Learn more about our care for:

Choosing Cook Children's for selective dorsal rhizotomy

At Cook Children's Spasticity Clinic, we provide a range of effective treatments, with SDR just one option. We always find the most appropriate approach for each child. If your child receives a recommendation for SDR, we work closely with your family before, during and after surgery.

When you select the Cook Children's team for spasticity care and possible selective dorsal rhizotomy, you can expect:

Team approach to care: Treating children with cerebral palsy requires collaboration among many specialties. Your child's care team includes experts in Neurology, Neurosurgery, Rehabilitation, Pain Management, Orthopedics and more.
Ongoing therapy: We provide one-on-one physical therapy for children before and after surgery — for years, if needed. The Physical Medicine and Rehabilitation program at Cook Children's is part of our Neurosciences Center. This arrangement allows our neurology specialists to stay involved in your child's therapy and closely track their progress.
Access to additional treatments: While SDR can be very effective, it's not an end goal. Many children still need orthopedic surgery in the future, which we can provide. Having SDR first to reduce spasticity helps make additional surgeries more successful.
Support for the whole family: Each family works with a dedicated case manager and social worker to help navigate your care. We're here to assist with the logistics of your child's surgery, hospital stay and at-home care. We also offer emotional support to aid your child and the rest of your family throughout the journey.
Extra help for out-of-town families: About half of the families who come to us for SDR surgery don't live nearby. We help these families with planning, travel and housing — so they can focus on getting their children the best possible care. After surgery, we coordinate care with your local doctor to make ongoing treatment easier to manage.

What is selective dorsal rhizotomy (SDR)?

For some children with cerebral palsy, selective dorsal rhizotomy may reduce pain and spasticity, making it easier to control and move their limbs.

Spasticity results from overactive sensory nerves in the muscles. These nerves send commands to the spinal cord telling the muscles to tense. During selective dorsal rhizotomy, a neurosurgeon identifies and cuts the most overactive sensory nerve fibers. The neurosurgeon leaves properly functioning nerves intact.

By cutting carefully selected nerves, the neurosurgeon limits the signals to the spinal cord telling the muscles to tense. This intervention helps reduce spasticity.

Who is a candidate for SDR surgery?

Selective dorsal rhizotomy is not the right treatment for all children with spastic cerebral palsy. It's a complex procedure that requires a long hospital stay and intensive therapy to regain function.

Our experts perform multiple evaluations of muscle function, limb spasticity and motor control to help determine if SDR is the best option.

Factors that may make your child a candidate for SDR include:

Age: We feel that the ideal time to perform the surgery is between 4 and 8 years old. Children need to be old enough to cooperate with instructions and effectively participate in their post-surgery therapy. But it also helps to intervene before muscles further develop. We can operate on older children, but in some cases, age-related muscle changes make the procedure less successful.
Mobility: We primarily recommend SDR surgery for children who have some ability to walk — either on their own or with assistance. However, we do occasionally offer SDR to children who aren't mobile. For those children, the goal of surgery is to reduce pain and make their care easier.
Premature birth: Children born prematurely are more likely to have cerebral palsy with spastic diplegia, making them candidates for SDR.

What to expect from SDR surgery

Deciding on dorsal rhizotomy surgery requires a long-term commitment. From evaluation and planning through surgery and rehab, the process may take six months or more. Our team works with families throughout each step, making sure they have the support they need.

The SDR surgery itself takes at least eight hours. After surgery, children spend about 48 hours in our Intensive Care Unit (ICU) for observation and pain management. Once they're ready to leave the ICU, they move into our rehabilitation unit.

Children typically stay in the rehab unit for about four weeks. During this time, our team works closely with children and their families. We believe that intensive, in-patient therapy helps children quickly regain motor skills, relearn muscle movements and improve mobility.