Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled tria
Related Experiment Video
Updated: Aug 2, 2026
3D Printing Model of a Patient's Specific Lumbar Vertebra
Published on: April 14, 2023
F V Wright1, E M Sheil, J M Drake
1Bloorview MacMillan Centre, Toronto, Ontario, Canada.
Insights
Selective dorsal rhizotomy (SDR) significantly improves gross motor function in children with cerebral palsy (CP) when combined with therapy. This surgical intervention, alongside physiotherapy and occupational therapy, offers greater functional gains than therapy alone.
Area of Science:
- Neurosurgery
- Pediatric Rehabilitation
- Movement Science
Background:
- Selective dorsal rhizotomy (SDR) is a surgical procedure used for spasticity in children with cerebral palsy (CP).
- Previous studies have not conclusively demonstrated functional outcome improvements following SDR.
- The current study aimed to rigorously assess the functional impact of SDR in pediatric CP.
Purpose of the Study:
- To compare gross motor function changes in children with diplegic CP 1 year after SDR plus therapy versus therapy alone.
- To evaluate the effect of SDR on spasticity, range of motion, and gait biomechanics.
- To provide conclusive evidence on the efficacy of SDR in improving functional outcomes for children with CP.
Main Methods:
- A randomized controlled trial involving 24 children with mild to moderate spastic diplegic CP.
- Participants were assigned to either a control group (CG) receiving physiotherapy (PT) and occupational therapy (OT) or a rhizotomy group (RG) receiving SDR followed by an intensive in-patient therapy program.
- The Gross Motor Function Measure (GMFM) was the primary outcome measure, assessed at baseline, 6, and 12 months, with secondary measures including tone, range of motion (ROM), and gait analysis.
Main Results:
- The rhizotomy group (RG) showed significantly greater improvement in GMFM scores (12.1 percentage points) compared to the control group (CG) (4.4 percentage points) (P<0.02).
- RG exhibited significant reductions in knee and ankle tone (P<0.005) and increased passive ankle ROM (P<0.001).
- Improvements in foot-floor contact patterns (P<0.05) and reduced soleus EMG reflex activity were observed in the RG.
Conclusions:
- Selective dorsal rhizotomy combined with intensive physiotherapy and occupational therapy leads to significantly greater functional motor improvement in children with CP at 1 year post-surgery.
- The functional gains are associated with reduced spasticity, improved range of motion, and more normalized gait biomechanics.
- SDR is an effective intervention for improving gross motor function in children with spastic diplegic cerebral palsy.
Abstract:
Selective dorsal rhizotomy (SDR) is widely used to treat spasticity in children with diplegic cerebral palsy (CP) but has never been shown conclusively to improve functional outcome. The study was designed to measure changes in gross motor function in children 1 year following rhizotomy compared with a control group receiving equivalent physiotherapy (PT) and occupational therapy (OT) with the exception that the rhizotomy group initially underwent a 6-week postoperative in-patient therapy program. Twenty-four children (mean age 58 months) with mild to moderate CP with spastic diplegia were randomly assigned to a therapy-only control group (CG) (N=12) or rhizotomy and therapy group (RG) (N=12). The Gross Motor Function Measure (GMFM) was administered at the baseline, 6-, and 12-month assessments. Extremity tone, range of motion (ROM), biomechanics of the ankle-stretch reflex, isometric contraction, and temporal gait components were also evaluated. GMFM scores in the RG improved by 12.1 percentage points versus 4.4 percentage points in the CG (P<0.02). RG knee and ankle tone was significantly reduced (P<0.005), associated with increased passive ankle ROM (P<0.001), and decreased soleus EMG reflex activity on forced dorsiflexion (P<0.008). Foot-floor contact pattern improved in the RG compared with the CG (P<0.05). In conclusion, SDR combined with PT and OT leads to significantly greater functional motor improvement at 1 year following surgery compared with PT and OT alone. This was achieved in part through reduced knee and ankle tone, increased ankle dorsiflexion ROM, and more normal foot-floor contact during walking.
