In which CP population is Selective Dorsal Rhizotomy (SDR) typically considered?

• A. Adults with hemiplegia who had a stroke.
• B. Children with spastic diplegia who have significant tone causing functional limitations and good selective motor control, usually before adolescence.
• C. Children with dyskinetic CP with minimal spasticity.
• D. Any CP patient regardless of subtype.

Answer: (B)

Selective Dorsal Rhizotomy is best suited for children with spastic diplegia who have significant leg spasticity that limits function, but who still demonstrate some ability to selectively activate muscles. The procedure works by reducing sensory input from the lumbar nerve roots, which lowers spinal reflex hyperexcitability and decreases lower-limb tone. When this reduction is combined with intensive postoperative rehabilitation, it can lead to meaningful improvements in gait and mobility. The child’s age matters because gains are optimized when performed before adolescence, when there is still neuroplastic potential and before fixed contractures limit movement. It’s not appropriate for dyskinetic CP, where movement problems are primarily dystonia or movement variability rather than pure spasticity, nor is it typically pursued in adults or when spasticity is not a primary limitation.