Selective Dorsal Rhizotomy for Children With Spastic Cerebral Palsy

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Why Nationwide Children's?

The Selective Dorsal Rhizotomy (SDR) Program at Nationwide Children’s Hospital in Columbus, Ohio, is one of the only programs of its kind in the United States. SDR, a spinal surgery usually performed on children with spastic cerebral palsy (CP), can improve mobility, reduce pain and relieve lower limb spasticity.

Spasticity is a condition that causes stiff, tight muscles that can’t be controlled because of a problem with the signals the brain sends – or doesn’t send – to a person’s nerves. The nerves causing the most tension are cut during this unique surgery. This can also reduce the number of additional orthopedic surgeries needed over the course of a child’s life. In most cases, spasticity doesn’t return.

At Nationwide Children’s, our nationally ranked team of surgeons, nurses and rehabilitation specialists will see you through every step of the process – from initial consult to post-surgery therapy.

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Selective dorsal rhizotomy (SDR) is offered by only a handful of pediatric hospitals in the United States and only a few surgeons are trained in the technique. Jeffrey Leonard, MD, has decades of experience performing this complicated procedure. He came to Nationwide Children’s from St. Louis Children’s, where he mastered the surgery working closely with the late T.S. Park, MD, the recognized pioneer in SDR.

Dr. Leonard is director of the SDR Program and chief of Neurosurgery at Nationwide Children’s. He is also a professor of Neurological Surgery at The Ohio State University College of Medicine and serves on the Research Steering Committee of the Cerebral Palsy Research Network (CPRN).

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Q: Who is a good candidate for selective dorsal rhizotomy (SDR)?

A: Most candidates for SDR have spastic cerebral palsy (CP). Children may be a good candidate for SDR if:

  • They have some ability to walk – with help or by themselves – but are limited by spasticity in the legs.
  • They are not mobile and have spasticity affecting all four limbs that makes daily care, like getting dressed and putting on a diaper, difficult.

Children with brain or spinal cord injuries may also be good candidates for the surgery.

Q: What does the surgery entail?

A: The selective dorsal rhizotomy procedure lasts about four hours. The surgeon opens a small section of the spine, finds and cuts the nerves causing the most tension. After surgery, children should have better control of their muscles. Selective dorsal rhizotomy does not cause floppy or limp arms or legs.

Q: How long should we expect to stay at the hospital?

A: At Nationwide Children’s, patients undergoing selective dorsal rhizotomy should expect to stay in the hospital for three weeks. The first week is spent in intensive care and the neuroscience unit, and the last two weeks are in the inpatient rehabilitation unit.

Q: What kind of rehabilitation or therapy is needed after surgery?

A: Selective dorsal rhizotomy patients participate in physical rehabilitation two times per day for two weeks during their stay at Nationwide Children’s. During these sessions, a therapist works with the child to improve muscle strength, control, and coordination using exercises, games and assistive technologies. Physical therapy also focuses on improving balance, walking, sitting, standing, and other motor skills and muscle control.

Q: Will rehabilitation or therapy continue after we go home?

A: Before leaving the hospital, a therapist teaches patient families how to do therapy and exercise at home. It is important that these exercises are completed so the child continues to make progress. Additionally, once a child returns home, outpatient rehabilitation visits continue four to five times per week for six months.

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Watch how a whole new world has opened for Ruby after selective dorsal rhizotomy surgery and follow-up physical therapy.

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