Evaluation of the effects of selective dorsal rhizotomy

Selective dorsal rhizotomy (SDR) is performed for relief of severe spasticity in patients with cerebral palsy (CP). The surgical procedure is designed to ablate a select portion of dorsal spinal root segments that are contributing to abnormal tone and interfering with appropriate function. The surgery is reported to reduce spasticity, improve independent mobility, facilitate activities of daily living, and reduce the risk of common complications of spasticity in CP. Optimistic, uncontrolled studies with largely subjective outcome measures were responsible for increased enthusiasm and expanded use of the procedure during the last decade. Evaluation of the functional benefits of the procedure using prospective, randomized, controlled trials has only recently been undertaken. Without a valid test for efficacy, the independent effect of SDR cannot be separated from the effects of other interventions, such as physical therapy, the considerable power of parental expectations, the increasing maturity in developing children with CP, and placebo effect. Scientific studies of the neurophysiologic and functional benefits of SDR are in progress at several centers at the present time and will likely yield valuable information about the efficacy of the procedure. MRDD Research Reviews 3:168-174, 1997.