Selective dorsal rhizotomy: an illustrated review of operative techniques

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Selective dorsal rhizotomy (SDR) is a procedure primarily performed to improve function in a subset of children with limitations related to spasticity. There is substantial variability in operative techniques among centers and surgeons. Here, the authors provide a technical review of operative approaches for SDR.


Ovid MEDLINE, Embase, and PubMed databases were queried in accordance with PRISMA guidelines. All studies included described a novel surgical technique. The technical nuances of each approach were extracted, including extent of exposure, bone removal, and selection of appropriate nerve roots. The operative approach preferred at the authors’ institution (the “2 × 3 exposure”) is also detailed.


Five full-text papers were identified from a total of 380 articles. Operative approaches to SDR varied significantly with regard to level of exposure, extent of laminectomy, and identification of nerve roots. The largest exposure involved a multilevel laminectomy, while the smallest exposure involved a keyhole interlaminar approach. At the Hospital for Sick Children, the authors utilize a two-level laminoplasty at the level of the conus medullaris. The benefits and disadvantages of the spectrum of techniques are discussed, and illustrative figures are provided.


Surgical approaches to SDR vary considerably and are detailed and illustrated in this review as a guide for neurosurgeons. Future studies should address the long-term impact of these techniques on functional outcomes and complications such as spinal deformity.

ABBREVIATIONS CP = cerebral palsy; EMG = electromyography; SDR = selective dorsal rhizotomy.

Supplementary Materials

  • Supplementary Figs. 1 and 2 (PDF 470 KB)
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Contributor Notes

Correspondence George M. Ibrahim: Hospital for Sick Children, Toronto, ON, Canada. WHEN CITING Published online February 7, 2020; DOI: 10.3171/2019.12.PEDS19629.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.


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