Selective dorsal rhizotomy

Stimulation and transection of

selective posterior rootlets.
Laminectomy at L2-L5.
Selective dorsal rhizotomy

Facet joints excluded, if possible to

prevent
Spinal-column instability and
secondary deformity.
Now only 2 level laminectomies.
Irreversible reduction in spasticity,
Transient weakness may occur,
Long-term PT and orthotics needed.
Selective dorsal rhizotomy
Not indicated for athetosis, ataxia, rigidity,
dystonia, muscle weakness,
overlengthened tendons, or severe fixed
contracture.
Earlier use of SDR reduces need of
orthopedic surgery,
May accelerate hip sub-luxation, increase
pelvic-tilt in ambulatory patients, and
exaggerate lumbar lordosis and speeds
progression of scoliosis, hind foot valgus
and mid-foot collapse.