For certain children with spasticity, selective dorsal rhizotomy (SDR) can dramatically improve walking ability—for the rest of their lives. Yet many children who could benefit most are never evaluated for the procedure.

“Selective dorsal rhizotomy is most effective when a child is still able to walk,” says Virendra R. Desai, MD, a pediatric neurosurgeon and Surgical Director of the Comprehensive Epilepsy Center at Children’s Hospital Los Angeles. “Unfortunately, surgery often isn’t considered until that ability has clearly declined. By then, the window of opportunity may have closed.”

At CHLA, specialists across Neurology, Neurosurgery, Orthopedics, and Rehabilitation work together to evaluate children with spasticity—most commonly associated with cerebral palsy—and determine the most appropriate treatment. The approach combines objective gait analysis with a full spectrum of medical and surgical options, including SDR. 

SDR reduces spasticity by interrupting abnormal sensory nerve signals that drive excessive muscle tone. For children who meet strict selection criteria, the procedure can preserve mobility and increase how far and how long they can walk.

The effectiveness of SDR is supported by multiple randomized controlled clinical trials, which clearly showed that individuals walk significantly better after the procedure. In addition, long‑term studies found that even 30 years after SDR, patients were walking as if they had never had any issues.

“Before SDR, a child might be able to walk about 10 minutes before needing a break,” Dr. Desai says. “After SDR and therapy, that same child may be able to walk for hours before getting tired.”

The challenge, he says, is that the children most likely to benefit are often the least likely to be referred. Ideal candidates are typically younger, ambulatory children with spasticity affecting the lower extremities.

Although these children may appear to be “doing well,” inefficient gait patterns can become harder to sustain as they grow. Young children might have the strength to ambulate now, but as they grow older they may lose that capacity. SDR can preserve the ability to walk, well into adulthood.

“The goal of SDR is to preserve walking, not restore it,” Dr. Desai says. “For the right patient, intervening earlier can make an enormous difference over a lifetime.”

Because SDR is irreversible, accurate patient selection is essential. A key step is distinguishing spasticity from other movement disorders, particularly dystonia, which can look similar.

“Both conditions cause muscle tightness, but the underlying physiology is different,” Dr. Desai explains. “SDR can be very effective for spasticity, but it can worsen dystonia.”

Distinguishing between the two relies on detailed clinical assessment, says Quyen Luc, MD, who leads the Movement Disorders Clinic in CHLA’s Neurological Institute.

“We don’t rely on a single test,” Dr. Luc says. “We carefully examine how a child moves, how muscles respond to speed and position, and how those patterns change. It’s a comprehensive evaluation.”

Objective gait analysis plays a central role in that evaluation. CHLA’s John C. Wilson Jr. Motion and Sports Analysis Lab—one of only about two dozen fully accredited pediatric gait labs in the country—provides detailed data on joint motion, forces across the joints, and muscle activation patterns during walking.

“That data helps us distinguish spasticity from other movement patterns and assess whether a child is likely to benefit from SDR,” says Robert M. Kay, MD, Director of the Jackie and Gene Autry Orthopedic Center at CHLA and Associates Chair in Orthopedics.

Gait analysis also helps guide long‑term care. “Postoperative gait studies establish a new functional baseline,” Dr. Kay notes, “allowing clinicians to track whether gains are maintained over time.” 

While SDR can be transformative, it’s not indicated for every patient. Many children with spasticity are instead best managed with physical therapy, bracing, medications, and botulinum toxin injections.

“If spasticity isn’t treated appropriately, it can permanently affect muscles and joints,” says Kevan Craig, DO, Chief of Rehabilitation Medicine at CHLA. “Medical management, combined with physical therapy, is critical for reducing pain and supporting joint health and function.”

Physical therapy is also essential for children who undergo SDR. “Surgery sets the stage, but long‑term gains in mobility depend on intensive rehabilitation,” Dr. Desai says.

Ultimately, children with spasticity benefit from being evaluated at a high-volume center that can offer the full spectrum of care. “We tailor treatment to what each child needs,” Dr. Desai says. “That includes recognizing who will benefit from surgery—and making sure that opportunity isn’t missed.”

(Newswise/HG)