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Treatments and Procedures: Selective Dorsal Rhizotomy

Selective dorsal rhizotomy (SDR) is a neurosurgical procedure that can improve mobility for many children who have spasticity with dystonia (increased muscle stiffness and spasms), including children living with cerebral palsy (CP). The procedure involves a hospital stay of several days, followed by a rigorous physical therapy program to "retrain" the brain, nerves and muscles.

"Think about it this way: When your cell phone gets bad reception, it's harder to hear what someone is saying. Selective dorsal rhizotomy helps 'improve reception' by clearing the communication lines between the body's spinal cord nerves and muscles, which helps decrease muscle tone and stiffness." 

--Shenandoah "Dody" Robinson, M.D., pediatric neurosurgeon and specialist in selective dorsal rhizotomy.

Selective Dorsal Rhizotomy (SDR): Why Choose Johns Hopkins

  • Johns Hopkins' pediatric neurosurgeons confer and collaborate with their colleagues in neurology, anesthesiology, pain management, physical medicine and rehabilitation and orthopaedics so your child has the benefit of an entire team working together.
  • We communicate with you and your child so you understand what to expect at each stage and how you can support your child throughout the procedure and recovery.
  • Our neurosurgeons are skilled in less invasive techniques for SDR, which can mean less pain for your child after the procedure and a quicker return to physical therapy.

Spastic Cerebral Palsy Surgical and Rehabilitation Treatment | Journee’s Story

Journee, age 4, was born with cerebral palsy. She and her mother traveled from Boston to meet pediatric orthopaedic surgeon Ranjit Varghese and neurosurgeon Shenandoah Robinson. Journee's surgeons developed a treatment plan with the rehabilitation team at the Kennedy Krieger Institute to get her standing and walking for the first time.

 

Selective Dorsal Rhizotomy (SDR): What to Expect

illustration of spine and nerve roots

The surgery takes three to four hours and is performed in the operating room, with the child is completely asleep under general anesthesia. The surgeons make an opening in the spine and expose the dorsal nerve roots that extend from the bottom of the spinal cord.

The surgeon uses a special microscope to test the sensory nerve "rootlets" that help the leg muscles "communicate" with the spinal cord. The microscope helps the surgeon identify any rootlets that are not functioning properly. The surgeon cuts these malfunctioning nerves, then closes the incision.

Recovery involves a few days in the hospital. For the first three days or so, the child will lie flat so the incision can heal. Skilled neurosurgery nurses and technologists will ensure your child has medicine to control pain. 

Afterward, the child will begin an intensive physical therapy program with two to three sessions per week for at least six weeks. This essential aspect of the procedure helps "retrain" the brain, nerves and muscles to work together more effectively, and is a key factor in the success of SDR.

Shenandoah RobinsonDr. Shenandoah Robinson, M.D., pediatric neurosurgeon and SDR expert

Maximizing the Benefit of Selective Dorsal Rhizotomy

A multidisciplinary team approach and patient selection are key to achieving best outcomes for cerebral palsy patients who undergo surgery to reduce muscle spasticity. Read more.

Patient Resources

Selective dorsal rhizotomy (SDR) is one option that can lead to improved movement for children living with cerebral palsy. Johns Hopkins pediatric neurosurgeon Shenandoah “Dody” Robinson, M.D. helps you understand more about the procedure in Selective Dorsal Rhizotomy for Cerebral Palsy: What You Need to Know.

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