Repeat selective dorsal rhizotomy for residual spasticity: illustrative case

BACKGROUND Selective dorsal rhizotomy (SDR) is typically a one-time surgical procedure supported by intense rehabilitation to improve ambulatory capability in children with spastic cerebral palsy (CP). OBSERVATIONS The authors present the unique case of a teenager with spastic diplegic CP who had undergone L2–S1 SDR as a child and presented with residual focal spasticity in the right plantar flexors. He underwent revision SDR at the right L5 and S1 levels in addition to decompression of canal stenosis. Postoperatively, he had notable improvement in his gait with relief of preoperative right knee and foot pain, improved ease of ambulation, and improved gait mechanics by 3D gait analysis. LESSONS The authors demonstrate the feasibility of revision focal SDR for persistent spasticity following SDR in the appropriately chosen patient. https://thejns.org/doi/10.3171/CASE25433