Selective Dorsal Rhizotomy

Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy
Nelleke G. Langerak and A. Graham Fieggen
Division of Neurosurgery, University of Cape Town, Cape Town South Africa
Selective dorsal rhizotomy (SDR) is a neurosurgical procedure to reduce the abnormal tone in the legs of children with bilateral spastic Cerebral Palsy (CP). Because SDR is not reversible, it’s important that children are properly evaluated before surgery.
Based on a systematic review of 52 articles, we identified 18 criteria to select children for surgery. These varied widely and included criteria linked to the child’s:
  • physical status (such as spasticity)
  • level of activity (such as functional level)
  • personal and environmental factors (such as age and motivation). 
These selection criteria varied considerably and were not standardized. This may partially explain the difference in outcomes of SDR. It would be helpful to achieve international consensus on selection of patients for SDR, to ensure that all eligible children, whether from low or high income countries, have an opportunity to benefit from this operation.
Mac Keith Press publishes two series of books: the Clinics in Developmental Medicine and the International Reviews of Child Neurology Series for the International Child Neurology Association.