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..
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