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Selective dorsal rhizotomy in ambulant children with cerebral palsy: an observational cohort study
Jennifer Summers1, Bola Coker1, Saskia Eddy1
1School of Population Health and Environmental Sciences, King's College London, London, UK.
Insights
Selective dorsal rhizotomy (SDR) surgery improved gross motor function and quality of life for children with cerebral palsy (GMFCS levels II-III). This led to SDR being funded by NHS England for eligible children.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Rehabilitation Medicine
Background:
- Selective dorsal rhizotomy (SDR) is a surgical procedure targeting specific sensory nerve roots.
- It is followed by intensive physiotherapy to enhance functional outcomes.
- The procedure aims to improve quality of life for children with cerebral palsy (CP) classified under GMFCS levels II and III.
Purpose of the Study:
- To assess the impact of SDR on gross motor function in children with CP.
- To evaluate postoperative quality of life changes following SDR.
- To provide evidence for NHS England's commissioning of SDR.
Main Methods:
- A prospective observational study was conducted across five English hospitals.
- Participants included children aged 3-9 years with spastic diplegic cerebral palsy.
- Primary outcomes measured were changes in the Gross Motor Function Measure (GMFM-66) and seven domains of the Cerebral Palsy Quality of Life Questionnaire (CP-QoL) over 24 months post-SDR.
Main Results:
- 137 children underwent SDR between September 2014 and March 2016.
- Mean GMFM-66 scores increased significantly post-SDR (annual change of 3.2 units).
- Five of seven CP-QoL domains showed significant improvements, including feelings about functioning and participation; pain and disability impact decreased.
Conclusions:
- Selective dorsal rhizotomy (SDR) demonstrates efficacy in improving both function and quality of life for children with cerebral palsy (GMFCS levels II-III) within 24 months.
- The observed positive outcomes informed an interim national policy decision to fund SDR for eligible children in England starting in 2018.
Background:
Selective dorsal rhizotomy (SDR) is an irreversible surgical procedure involving the division of selected sensory nerve roots, followed by intensive physiotherapy. The aim is to improve function and quality of life in children with cerebral palsy and a Gross Motor Function Classification System (GMFCS) level of II or III (walks with or without assistive devices, respectively). We assessed gross motor function before and after SDR and postoperative quality of life in a study commissioned by NHS England.
Methods:
We did a prospective observational study in five hospitals in England who were commissioned to perform SDR on children aged 3-9 years with spastic diplegic cerebral palsy. The primary outcome was score changes in the 66-item Gross Motor Function Measure (GMFM-66) and seven domains of the Cerebral Palsy Quality of Life Questionnaire ([CP-QoL] social wellbeing and acceptance, feelings about functioning, participation and physical health, emotional wellbeing and self-esteem, access to services, family health, and pain and impact of disability) from before to 24 months after SDR.
Findings:
From Sept 4, 2014, to March 21, 2016, 137 children underwent SDR. The mean age was 6·0 years (SD 1·8). The mean GMFM-66 score increased after SDR with an annual change of 3·2 units (95% CI 2·9 to 3·5, n=137). Of the seven CP-QoL domains, five showed significant improvements over time: feelings about functioning mean annual change 3·0 units (95% CI 2·0 to 4·0, n=133), participation and physical health 3·9 units (2·5 to 5·3, n=133), emotional wellbeing and self-esteem 1·3 units (0·2 to 2·3, n=133), family health 2·0 units (0·7 to 3·3, n=132), and pain and impact of disability -2·5 units (-3·9 to -1·2, n=133). 17 adverse events were reported in 15 children, of which none were severe and 15 (88%) resolved.
Interpretation:
SDR improved function and quality of life in the 24 months after surgery in children with cerebral palsy classified as GMFCS levels II and III. On the basis of these findings, an interim national policy decision was made that SDR would be funded for eligible children in England from 2018.
Funding:
National Institute for Health and Care Excellence, National Institute for Health Research Biomedical Research Centre, NHS England.
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