The objective of this review is to analyze the evidence supporting selective dorsal
rhizotomy (SDR) for the treatment of
spastic cerebral palsy (CP). We reviewed 85 outcome studies from 12 countries between 1990 and 2017. The published results are overwhelmingly supportive of SDR, and 39 studies form a basis for this review. Also included is some of the clinical experience of the senior author. The results show that SDR plus postoperative physiotherapy (PT) improved gait, functional independence, and self-care in children with
spastic diplegia. In adults with a follow-up of 20 to 28 years, the early improvements after childhood SDR were sustained and improved quality of life. Furthermore, majority of the adults who underwent SDR as children would recommend SDR to others. On the clinical side, while SDRs through multilevel
laminectomies or
laminoplasty were associated with spinal
deformities (i.e.,
scoliosis, hyperlordosis,
kyphosis,
spondylolisthesis,
spondylolysis, and nonhealing of
laminoplasty), SDRs through a single level
laminectomy prevented SDR-related spinal problems. The outcomes of SDR specific to
spastic quadriplegia require further investigation because of the relatively small patient population with
quadriplegia. Lastly, we found that SDR can prevent or reverse
premature aging in adolescents and adults with
spastic diplegia. In conclusion, the evidence supporting the efficacy of SDR is strong, and SDR is a well-established option for spasticity management in
spastic CP.