No products in the cart.

No products in the cart.

Selective Dorsal Rhizotomy: Understanding This Procedure for Spasticity

child with cerebral palsy in hospital for selective dorsal rhizotomy surgery

Individuals with neurological conditions often experience involuntary muscle contractions called spasticity. If left unmanaged, spasticity can worsen over time and significantly restrict one’s mobility. To prevent spasticity from progressing, doctors may recommend a surgical procedure called selective dorsal rhizotomy (SDR).  

This treatment helps permanently reduce spasticity in the legs, and sometimes even in the upper extremities, which can promote ambulation and improve overall functional outcomes. However, SDRs are invasive and irreversible, so it’s essential to understand the benefits and risks of the procedure.

To help you understand what selective dorsal rhizotomy is, this article will discuss:

What Does Selective Dorsal Rhizotomy Involve?

A selective dorsal rhizotomy is a surgery that involves cutting sensory nerve fibers, typically in the L2 to S1 levels of the spinal cord to reduce the hyperexcitability of spastic muscles in the legs.

Spasticity occurs because damage to the central nervous system disrupts the transmission of messages between the brain and muscles. As a result, the muscles become hyperreactive to stimulation and contract. Because brain signals cannot reach the muscles and tell them to relax, they remain contracted.

During an SDR, incisions are made along the lower back and electromyography is used to observe abnormal muscle responses when specific nerve roots are stimulated. Once the nerve roots that cause overactive muscle contractions are identified, they will be cut so they can no longer activate muscle contractions.

Because cut nerves in the spinal cord cannot regenerate, the spasticity relief provided by SDR is often permanent.

Although selective dorsal rhizotomies for spasticity relief in individuals with cerebral palsy currently are performed on the lumbosacral portion of the spinal cord, there has been a limited amount of recent research on the effect of cervical SDR on upper limb spasticity in those with other neurological conditions.

One study found that cervical SDR reduced upper limb spasticity in an individual following a brain injury, while another found positive results in individuals who had upper limb spasticity following a stroke or spinal cord injury. Even though both of these studies were relatively small and did not include individuals with cerebral palsy, they demonstrate that there’s a possibility for cervical SDR to be used for upper limb spasticity in individuals with cerebral palsy in the future.

Of note, however, even lumbosacral SDR has been demonstrated to help with spasticity in the upper extremities of those with spastic quadriplegia, even though that is not the primary goal of the surgery.

Now that you understand what the procedure involves, let’s discuss who is an ideal candidate for it.

Who Is a Good Candidate for Selective Dorsal Rhizotomy?

A selective dorsal rhizotomy can help relieve spasticity in individuals with neurological injuries like stroke and spinal cord injury. However, it is most commonly performed in individuals with spastic cerebral palsy.

Cerebral palsy encompasses a wide range of motor disorders at varying severities caused by damage to the developing brain. Because everyone experiences CP differently, SDR may not be ideal for all individuals with CP.

Generally, the ideal candidate for selective dorsal rhizotomy will:

  • Have some ability to walk (assisted or independently)
  • Be between the ages of 3-8 years old
  • Have a type of CP called spastic diplegia
  • Have no prior history of orthopedic surgery

Individuals that do not meet these criteria (such as adults, individuals with other neurological injuries, and individuals with more severe CP) may also benefit from this procedure. However, there may be more effective or less invasive options available for your specific condition.

Other treatments for spasticity include orthopedic surgery, Botox, muscle relaxants, orthotic devices, and physical therapy. Depending on the severity of your spasticity and how much of the body it affects, your doctor may recommend these treatments instead.

The following section will discuss some of the benefits of selective dorsal rhizotomies.

What are the Benefits of Selective Dorsal Rhizotomy?

young boy with reduced spasticity in legs after selective dorsal rhizotomy

Spasticity can significantly restrict movement and decrease an individual’s quality of life by causing pain, poor sleep quality, and the inability to walk.

By reducing spasticity, SDR can promote:

  • Greater range of motion
  • Reduced muscle and joint pain
  • Improved quality of sleep
  • Improved gait
  • Better sitting and standing balance

A study that followed 294 adults who underwent selective dorsal rhizotomy as children found that the benefits of SDR continued into adulthood with no long-term complications. Likewise, individuals who received selective dorsal rhizotomies as children were significantly more likely to have less functional decline compared with age-matched controls.

Spasticity can place severe strain on the musculoskeletal system, causing the body to expend more energy to function and age at an increased rate. It’s suggested that by relieving spasticity, selective dorsal rhizotomies may be able to prevent premature aging in individuals with cerebral palsy.

Up next, we’ll discuss potential risks associated with this procedure.

What are Potential Complications of Selective Dorsal Rhizotomy?

As with any surgery, there are potential complications that may occur during or as a result of selective dorsal rhizotomy.

Possible risks[1], [2], [3] associated with selective dorsal rhizotomy include:

  • Infection
  • Hemorrhage
  • Leaking of cerebrospinal fluid
  • Numbness
  • Skin irritation
  • Reduced sensation
  • Spinal deformity
  • Bowel and bladder dysfunction
  • Back pain

If you experience any of these complications after your procedure, speak to your doctor as early as possible. The sooner these complications are identified and addressed, the less likely they are to progress and impact your quality of life.

The following sections will discuss the importance of participating in rehabilitative therapies after SDR. 

How to Optimize Functional Outcomes After Selective Dorsal Rhizotomy

Recovery after a selective dorsal rhizotomy always includes participation in rehabilitative therapies such as physical and occupational therapy. These interventions help individuals get accustomed to reduced spasticity in the legs and practice the exercises and activities necessary to improve their functional mobility.   

A physical therapist will have individuals practice targeted exercises that stimulate the muscles and improve movement patterns. In contrast, an occupational therapist will work on developing the client’s functional independence by practicing activities of daily living such as dressing or transferring.

Consistently practicing these rehabilitative exercises and activities will stimulate the central nervous system to make adaptive changes. Neuroplasticity is the brain and spinal cord’s ability to reorganize its neural circuitry. It allows for functions affected by spasticity or damage to the central nervous system to be rewired to unaffected regions and improved.

Neuroplasticity is significantly influenced by the behaviors you consistently perform. Therefore, repetitively practicing the specific exercises and activities you learn in rehabilitative therapies can help reinforce demand for those functions and promote adaptive changes.

Selective Dorsal Rhizotomy: Key Points

To permanently treat spasticity in individuals with spastic cerebral palsy, a doctor may recommend selective dorsal rhizotomy. This surgery involves cutting sensory nerve roots in the spinal cord to prevent overactive muscle contractions.

While SDR will not magically improve motor functions in individuals with cerebral palsy, the procedure can help improve their quality of life by preventing motor impairments from worsening and causing further complications. With the help of rehabilitative therapies, individuals can learn the exercises and activities necessary to promote neuroplasticity and improve their mobility.

We hope this article helped you understand what SDR is and how it can help individuals with cerebral palsy improve their functional abilities.

Keep it going: Don’t leave behind this free ebook with 19 pages of helpful tips for cerebral palsy

illustration of cerebral palsy tips ebook with example pages

Get our free 19-page PDF full of helpful tips for cerebral palsy by signing up below! If you liked this article, you’ll LOVE our free ebook.

When you sign up, you’ll also receive our popular emails that share more tips for life with cerebral palsy — you can opt out anytime.

We will never sell your email address, and we never spam. That we promise.

More Ways to Recover with Flint Rehab:

Free CP Tips Ebook

illustration of cerebral palsy tips ebook with example pages

Discover Award-Winning Neurorehab Tools

You're on a Roll: Read More Popular Articles About Cerebral Palsy

You’re Really on a Roll: Discover a Program for CP That’s Actually Fun to Do!

At Flint Rehab, we understand that doing physical therapy at home can become tedious and repetitive. But when repetition is critical to recovery, it’s important to stick with a repetitive regimen. But that doesn’t mean it has to be boring.

Flint Rehab is the leading manufacturer of motion-sensing, gamified rehabilitation devices. Our bestselling recovery tool, FitMi, transforms full-body rehab exercises into an interactive experience.

See what individuals with CP are saying about FitMi:

“The FitMi and MusicGlove have done wonders for my son with hemiparesis from cerebral palsy and stroke. It motivates him to do his exercises. It does not seem like therapy for him since it is fun. FitMi monitors his progress so it is a great reinforcement for him. Music is a motivator for him. He has been using it on his arm and we will try the leg exercises soon.”


While FitMi is a recovery tool for the full-body, our other device, MusicGlove, helps target the hand to improve fine motor skills and dexterity.

See what others have said about MusicGlove:

“My granddaughter has right-side hemiplegia from Cerebral Palsy / stroke at birth. She states that this is a great product for anyone who has issues with the use of their hand(s), and that is has helped her tremendously. She also finds the music quite catchy (surprisingly!). Our occupational therapist has been impressed as well. I can say that it has arguably been the best tool of all our therapy resources.”


Together, FitMi and MusicGlove make a powerful home therapy regimen for individuals with cerebral palsy. Best of all, you can save money when you bundle them together.

To learn more, click the button below:

ebook cover with the title "Helpful tips for managing cerebral palsy"

Do you have these 19 pages of helpful tips for CP?

Get a free copy of our ebook Helpful Tips for Managing Cerebral Palsy. Click here to get instant access.