Selective posterior rhizotomy (SPR)

Surgery Overview

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Selective posterior rhizotomy (SPR) is the most common nerve surgery for symptoms related to cerebral palsy (CP). During SPR, a surgeon cuts the skin over the lower part of the spinal cord. The surgeon then finds and cuts the nerves in the cord that are causing muscle tightness in the legs.

SPR also is called selective dorsal root rhizotomy or selective dorsal rhizotomy of the legs.

What To Expect After Surgery

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After surgery, physical therapy is needed. In addition, orthopedic surgery may still be necessary, as well as casts or braces.

Nerves that are cut during SPR do not grow back together. Sometimes not all nerves are cut, and other surgeries may be needed to cut those that remain.

Why It Is Done

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Selective posterior rhizotomy is done to relieve muscle tightness and spasticity in select children with a form of CP that severely affects the legs.¹ The procedure may also improve the range of movement in the legs.

SPR is especially useful when cerebral palsy affects both legs but not the arms (spastic diplegia). It is not recommended for people who have permanently bent joints (contractures), little strength in their limbs, or difficulty with balance.

How Well It Works

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Some children have less muscle tightness (spasticity) and are able to move their legs more easily after SPR, although their legs may feel weaker and somewhat numb. Sometimes, spasticity completely goes away.

This surgery may decrease the chances of leg deformities in growing children. When muscles tighten around growing bones, the bones may not develop normally.

SPR cuts the nerves that cause spasticity and helps prevent the muscle from tightening again. When SPR is done before orthopedic surgery to loosen tight muscles, it may increase the success of that surgery.

Although some studies have shown that SPR can improve function (such as sitting, walking, and standing) in some children with CP, other studies are less favorable for showing improvement in long-term functional abilities.¹

Risks

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SPR usually does not affect other functions of the body, such as bowel and bladder control or the ability to have sex. In rare cases, problems such as strange sensations or loss of control over the bladder can occur.

What To Think About

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Complications after SPR are rare. Children need to have physical therapy for up to 1 year after this surgery.

More study is needed to determine the long-term effects of SPR on the function and condition of the bones and joints.²

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Pellegrino L (2002). Cerebral palsy. In M Batshaw, ed., Children With Disabilities, 5th ed., pp. 443–466. Baltimore: Paul H. Brooks Publishing.

2. Petersen MC, Palmer FB (2001). Advances in prevention and treatment of cerebral palsy. Mental Retardation and Developmental Disabilities Research Reviews, 7: 30–37.

Credits

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Author	Sabra L. Katz-Wise
Author	Ralph Poore
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Louis Pellegrino, MD - Developmental Pediatrics
Last Updated	November 20, 2006