Selective dorsal rhizotomy (CP)

Selective dorsal rhizotomy (SDR) involves the cutting of approximately 50% of the dorsal sensory roots from
the spinal cord, thereby decreasing the muscle tone in the lower extremities(Abbott, 1996). As a result of
the decrease in the muscle tone, discomfort or pain may be alleviated, and sitting posture and/or gait may
improve. The ideal candidate is a child who has normal or near normal strength in the lower extremities,
has good trunk strenth, who has not developed fixed contractures and whose alteration of tone will lead to
the desired improvements in function. Combining the data from 3 separate studies that compared physical
therapy with SDR plus physical therapy revealed a direct relationship between percentage of dorsal root
tissue transected and functional improvement. SDR+PT is efficacious in reducing spasticity in children with
spastic diplegia and has a small positive effect on gross motor function (McLaughlin et al., 2002).
Intrathecal Baclofen Infusion (ITB)
Baclofen, a GABA agonist, administered intrathecally (next to the spinal cord) via an implanted pump (ITB)
has been helpful to patients whose muscle tone is more generalized and,whose muscle tone in interfering
with function.(Albright, 1996). As Baclofen dose not cross the blood-brain barrier very effectively, large
doses must be used orally to achieve success compared to administering baclofen intrathecally. Often, the
patient on oral medication becomes lethargic. The candidates for this intervention can be divided into 2
groups. The first group includes the patients whose gait is adversely affected by the muscle tone and who
have some underlying muscle weakness. SDR in these patients is contraindicated as the procedure will
cause additional muscle weakness, possibly causing an ambulatory patient to become non-ambulatory. A
second group of patients are those whose generalized tone interferes with activities such as hygiene,
transferring from a chair to a bed or just maintaining a safe upright position. Although the complication
rate, including infection and baclofen withdrawal symptoms, occurring as a result of catheter breakage or
leakage, is about 50%, parent satisfaction is extremely high with this type of intervention. Once the
complication is corrected, over 90% of the parents/caretakers/patients request that the pump be
reimplanted or the catheter be replaced (Albright and Ferson, 2006; Gooch et al., 2004).