Selective Posterior Rhizotomy (SPR)
Selective posterior rhizotomy, also called selective dorsal rhizotomy, is a surgery to the sensory nerves in the spinal cord. The surgery involves a neurosurgeon cutting some nerves in the spinal cord that make the muscles spastic. It is “selective” because the surgeon picks only those nerves that go to the muscles with the most spasticity. After the surgery, the spasticity is reduced in the muscles whose nerves were cut. In some cases, the muscles may be weak and a lot of therapy is needed after the surgery to regain strength.
Who may benefit
This procedure works best in children who walk but who have a lot of spasticity in their legs. Because the surgery may uncover weakness that was hidden by the spasticity, it is important that the child have good strength and the ability to use his or her muscles when the spasticity is taken away. The child also must be willing to participate in a prolonged, intensive therapy program after surgery.
Rhizotomy may also be done in children who cannot walk, but who have spasticity that is so severe that it limits their function. In those cases, the goal of the rhizotomy is to make it easier for someone to take care of the person
How it is done
The decision to have a selective posterior rhizotomy is made by the neurosurgeon and other members of the medical team. The child’s strength, ability to move and spasticity are measured. Function, included walking, is also observed. During the surgery, the doctor determines which muscles are most spastic. Only those nerves are cut. The hospital stay is five to seven days. Following surgery, intensive therapy are often needed to help the child get stronger. Children typically wear ankle braces for a period of time following surgery to provide stability and protect weak muscles.